The latest clinical practice guidelines for non-small cell lung cancer (NSCLC) published by the National Comprehensive Cancer Network in 2022 recommend that patients with NSCLC (>1 and ≤2 cm) should be diagnosed as T1b. Segmentectomy and lobectomy are equally effective in treating patients with NSCLC no bigger than 2 cm, and especially for tumors no bigger than 1 cm. However, the effectiveness of these treatments for NSCLC tumors between 1 and 2 cm is unknown. We conducted a systemic review and meta- analysis to assess the efficacy of these two surgical treatments in patients with T1b stage NSCLC.

We searched for randomized controlled trials (RCTs) and cohort studies investigating the efficacy of lobectomy and segmentectomy for patients with T1b stage NSCLC. Study quality was assessed with the Cochrane Quality in Prognosis Studies tool. We used random effects models to analyze overall survival (OS) and lung cancer-specific survival (LCSS), expressed as hazard ratios (HR) and 95% confidence intervals (CIs). The effect of covariates was assessed using subgroup analysis. All procedures were performed according to the PRISMA guidelines.

We identified ten cohort studies that matched our selection criteria, with general low risk of quality, including a total of 37,691 patients. No publication bias was found. Compared to lobectomy, segmentectomy had lower OS (HR 1.31, 95% CI: 1.16, 1.47; p=0.026) and LCSS (HR 1.21, 95% CI: 1.03, 1.42, p=0.015) before Cox regression. After multivariable Cox regression, adjusted by age, sex, histological type, and lymph node section, segmentectomy had similar OS (HR 1.17, 95% CI: 1.00, 1.37; p=0.2) and LCSS (HR 1.10, 95% CI: 0.89, 1.36; p=0.8).

Segmentectomy can be used to treat patients with T1b stage NSCLC. Patients who undergo segmentectomy have survival outcomes that are the same as those of patients who received lobectomy. This evidence-based observation provides a reference for surgical choice in the treatment of patients with T1b stage NSCLC, which should be further confirmed through RCTs.