European prognosis evaluation of early-stage lung adenocarcinoma patterns after lobectomy versus segmentectomy based on clinical stage settings

Lukadi Joseph Lula; Lin Huang; Clara Forcada Barreda; Rita Costa; Matic Domjan; Aimée J.P.M. Franssen; Crt Jasovic; Mohamed Rebei; Beatrice Trabalza Marinucci; Rebecca Weedle; Guillermo Rodriguez; Emrah Gökay Özgür; Kiarash Ghasemi; Jack Whooley; Erino Angelo Rendina; Ronan Ryan; Vincent Young; Gülnaz Nural Bekiroglu; Karen Redmond; Erik R. de Loos; Gerard J. Fitzmaurice; Ciprian Bolca; Adelino Leite Moreira; Cornel Savu; Antonio D'Andrilli; Tomaz Stupnik; Alessio Vincenzo Mariolo; Jozsef Furak; Marcelo Jimenez; Alessandro Brunelli; René Horsleben Petersen

doi:10.1016/j.xjon.2026.101687

European prognosis evaluation of early-stage lung adenocarcinoma patterns after lobectomy versus segmentectomy based on clinical stage settings

Lukadi Joseph Lula^*, Lin Huang, Clara Forcada Barreda, Rita Costa, Matic Domjan, Aimée J.P.M. Franssen, Crt Jasovic, Mohamed Rebei, Beatrice Trabalza Marinucci, Rebecca Weedle, Guillermo Rodriguez, Emrah Gökay Özgür, Kiarash Ghasemi, Jack Whooley, Erino Angelo Rendina, Ronan Ryan, Vincent Young, Gülnaz Nural Bekiroglu, Karen Redmond, Erik R. de LoosGerard J. Fitzmaurice, Ciprian Bolca, Adelino Leite Moreira, Cornel Savu, Antonio D'Andrilli, Tomaz Stupnik, Alessio Vincenzo Mariolo, Jozsef Furak, Marcelo Jimenez, Alessandro Brunelli, René Horsleben Petersen

^*Corresponding author for this work

Department of Cardiothoracic Surgery

Abstract

Objectives To investigate the prognosis of peripheral early-stage lung adenocarcinoma patterns treated by lobectomy or segmentectomy. Methods Retrospective multicentric cohort of patients with cT1a-bN0M0 lung adenocarcinoma who underwent lobectomy or segmentectomy with systematic lymph node dissection in 10 European centers (one per country) from 2015 to 2021. Overall survival (OS), disease-free survival (DFS), and lung cancer–specific death (LCSD) between both groups were assessed in entire dataset and in dataset of histologic aggressive patterns, before and after propensity score-matching (PSM). Prognostic risk factors were analyzed using parsimonious model Cox regression. Recurrences were assessed by linearized risks. Results Lobectomy and segmentectomy were performed in 1029 (73.1%) and 377 (26.8%) patients, respectively. In total, 427 (30.3%) patients had at least 1 histologic aggressive (micropapillary or solid) pattern, and 88 patients (20.7%) underwent segmentectomy. OS, DFS, and LCSD rates were similar between patients who underwent lobectomy or segmentectomy, in both datasets, before and after PSM. In aggressive dataset, PSM, 5-year OS rates were lobectomy 88.0% (95% CI, 80.9-95.7%), segmentectomy 89.1% (95% CI, 82.2-96.6%), P = .8; 5-year DFS rates were lobectomy 79.8% (95% CI, 70.8-89.8%), segmentectomy 80.6% (95% CI, 71.6-90.6%), P = .6; and 5-year LCSD rates were lobectomy 6.0%, segmentectomy 7.8%, P = .8. Locoregional recurrence was not superior in patients who underwent segmentectomy in entire dataset (linearized risks: lobectomy 0.078, segmentectomy 0.073) and in aggressive dataset (linearized risks: lobectomy 0.036, segmentectomy 0.011) only in the unmatched cohorts. Aggressive histologic patterns impacted on only LCSD, and only when they were dominant. Conclusions Segmentectomy seems comparable to lobectomy for patients with peripheral cT1a-bN0M0 lung adenocarcinoma even in case of histologic aggressive patterns.

Original language	English
Article number	101687
Journal	JTCVS Open
DOIs	https://doi.org/10.1016/j.xjon.2026.101687
Publication status	Accepted/In press - 2026

Keywords

lobectomy
lung adenocarcinoma
patterns
prognosis
segmentectomy

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10.1016/j.xjon.2026.101687Licence: CC BY

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Lula, L. J., Huang, L., Barreda, C. F., Costa, R., Domjan, M., Franssen, A. J. P. M., Jasovic, C., Rebei, M., Trabalza Marinucci, B., Weedle, R., Rodriguez, G., Özgür, E. G., Ghasemi, K., Whooley, J., Rendina, E. A., Ryan, R., Young, V., Bekiroglu, G. N., Redmond, K., ... Petersen, R. H. (Accepted/In press). European prognosis evaluation of early-stage lung adenocarcinoma patterns after lobectomy versus segmentectomy based on clinical stage settings. JTCVS Open, Article 101687. https://doi.org/10.1016/j.xjon.2026.101687

Lula, LJ, Huang, L, Barreda, CF, Costa, R, Domjan, M, Franssen, AJPM, Jasovic, C, Rebei, M, Trabalza Marinucci, B, Weedle, R, Rodriguez, G, Özgür, EG, Ghasemi, K, Whooley, J, Rendina, EA, Ryan, R, Young, V, Bekiroglu, GN, Redmond, K, de Loos, ER, Fitzmaurice, GJ, Bolca, C, Moreira, AL, Savu, C, D'Andrilli, A, Stupnik, T, Mariolo, AV, Furak, J, Jimenez, M, Brunelli, A & Petersen, RH 2026, 'European prognosis evaluation of early-stage lung adenocarcinoma patterns after lobectomy versus segmentectomy based on clinical stage settings', JTCVS Open. https://doi.org/10.1016/j.xjon.2026.101687

@article{c37cb40d0cd44538815911573f8ef570,

title = "European prognosis evaluation of early-stage lung adenocarcinoma patterns after lobectomy versus segmentectomy based on clinical stage settings",

abstract = "Objectives To investigate the prognosis of peripheral early-stage lung adenocarcinoma patterns treated by lobectomy or segmentectomy. Methods Retrospective multicentric cohort of patients with cT1a-bN0M0 lung adenocarcinoma who underwent lobectomy or segmentectomy with systematic lymph node dissection in 10 European centers (one per country) from 2015 to 2021. Overall survival (OS), disease-free survival (DFS), and lung cancer–specific death (LCSD) between both groups were assessed in entire dataset and in dataset of histologic aggressive patterns, before and after propensity score-matching (PSM). Prognostic risk factors were analyzed using parsimonious model Cox regression. Recurrences were assessed by linearized risks. Results Lobectomy and segmentectomy were performed in 1029 (73.1\%) and 377 (26.8\%) patients, respectively. In total, 427 (30.3\%) patients had at least 1 histologic aggressive (micropapillary or solid) pattern, and 88 patients (20.7\%) underwent segmentectomy. OS, DFS, and LCSD rates were similar between patients who underwent lobectomy or segmentectomy, in both datasets, before and after PSM. In aggressive dataset, PSM, 5-year OS rates were lobectomy 88.0\% (95\% CI, 80.9-95.7\%), segmentectomy 89.1\% (95\% CI, 82.2-96.6\%), P = .8; 5-year DFS rates were lobectomy 79.8\% (95\% CI, 70.8-89.8\%), segmentectomy 80.6\% (95\% CI, 71.6-90.6\%), P = .6; and 5-year LCSD rates were lobectomy 6.0\%, segmentectomy 7.8\%, P = .8. Locoregional recurrence was not superior in patients who underwent segmentectomy in entire dataset (linearized risks: lobectomy 0.078, segmentectomy 0.073) and in aggressive dataset (linearized risks: lobectomy 0.036, segmentectomy 0.011) only in the unmatched cohorts. Aggressive histologic patterns impacted on only LCSD, and only when they were dominant. Conclusions Segmentectomy seems comparable to lobectomy for patients with peripheral cT1a-bN0M0 lung adenocarcinoma even in case of histologic aggressive patterns.",

keywords = "lobectomy, lung adenocarcinoma, patterns, prognosis, segmentectomy",

author = "Lula, \{Lukadi Joseph\} and Lin Huang and Barreda, \{Clara Forcada\} and Rita Costa and Matic Domjan and Franssen, \{Aim{\'e}e J.P.M.\} and Crt Jasovic and Mohamed Rebei and \{Trabalza Marinucci\}, Beatrice and Rebecca Weedle and Guillermo Rodriguez and {\"O}zg{\"u}r, \{Emrah G{\"o}kay\} and Kiarash Ghasemi and Jack Whooley and Rendina, \{Erino Angelo\} and Ronan Ryan and Vincent Young and Bekiroglu, \{G{\"u}lnaz Nural\} and Karen Redmond and \{de Loos\}, \{Erik R.\} and Fitzmaurice, \{Gerard J.\} and Ciprian Bolca and Moreira, \{Adelino Leite\} and Cornel Savu and Antonio D'Andrilli and Tomaz Stupnik and Mariolo, \{Alessio Vincenzo\} and Jozsef Furak and Marcelo Jimenez and Alessandro Brunelli and Petersen, \{Ren{\'e} Horsleben\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s).",

year = "2026",

doi = "10.1016/j.xjon.2026.101687",

language = "English",

journal = "JTCVS Open",

issn = "2666-2736",

publisher = "Elsevier BV",

}

TY - JOUR

T1 - European prognosis evaluation of early-stage lung adenocarcinoma patterns after lobectomy versus segmentectomy based on clinical stage settings

AU - Lula, Lukadi Joseph

AU - Huang, Lin

AU - Barreda, Clara Forcada

AU - Costa, Rita

AU - Domjan, Matic

AU - Franssen, Aimée J.P.M.

AU - Jasovic, Crt

AU - Rebei, Mohamed

AU - Trabalza Marinucci, Beatrice

AU - Weedle, Rebecca

AU - Rodriguez, Guillermo

AU - Özgür, Emrah Gökay

AU - Ghasemi, Kiarash

AU - Whooley, Jack

AU - Rendina, Erino Angelo

AU - Ryan, Ronan

AU - Young, Vincent

AU - Bekiroglu, Gülnaz Nural

AU - Redmond, Karen

AU - de Loos, Erik R.

AU - Fitzmaurice, Gerard J.

AU - Bolca, Ciprian

AU - Moreira, Adelino Leite

AU - Savu, Cornel

AU - D'Andrilli, Antonio

AU - Stupnik, Tomaz

AU - Mariolo, Alessio Vincenzo

AU - Furak, Jozsef

AU - Jimenez, Marcelo

AU - Brunelli, Alessandro

AU - Petersen, René Horsleben

PY - 2026

Y1 - 2026

N2 - Objectives To investigate the prognosis of peripheral early-stage lung adenocarcinoma patterns treated by lobectomy or segmentectomy. Methods Retrospective multicentric cohort of patients with cT1a-bN0M0 lung adenocarcinoma who underwent lobectomy or segmentectomy with systematic lymph node dissection in 10 European centers (one per country) from 2015 to 2021. Overall survival (OS), disease-free survival (DFS), and lung cancer–specific death (LCSD) between both groups were assessed in entire dataset and in dataset of histologic aggressive patterns, before and after propensity score-matching (PSM). Prognostic risk factors were analyzed using parsimonious model Cox regression. Recurrences were assessed by linearized risks. Results Lobectomy and segmentectomy were performed in 1029 (73.1%) and 377 (26.8%) patients, respectively. In total, 427 (30.3%) patients had at least 1 histologic aggressive (micropapillary or solid) pattern, and 88 patients (20.7%) underwent segmentectomy. OS, DFS, and LCSD rates were similar between patients who underwent lobectomy or segmentectomy, in both datasets, before and after PSM. In aggressive dataset, PSM, 5-year OS rates were lobectomy 88.0% (95% CI, 80.9-95.7%), segmentectomy 89.1% (95% CI, 82.2-96.6%), P = .8; 5-year DFS rates were lobectomy 79.8% (95% CI, 70.8-89.8%), segmentectomy 80.6% (95% CI, 71.6-90.6%), P = .6; and 5-year LCSD rates were lobectomy 6.0%, segmentectomy 7.8%, P = .8. Locoregional recurrence was not superior in patients who underwent segmentectomy in entire dataset (linearized risks: lobectomy 0.078, segmentectomy 0.073) and in aggressive dataset (linearized risks: lobectomy 0.036, segmentectomy 0.011) only in the unmatched cohorts. Aggressive histologic patterns impacted on only LCSD, and only when they were dominant. Conclusions Segmentectomy seems comparable to lobectomy for patients with peripheral cT1a-bN0M0 lung adenocarcinoma even in case of histologic aggressive patterns.

AB - Objectives To investigate the prognosis of peripheral early-stage lung adenocarcinoma patterns treated by lobectomy or segmentectomy. Methods Retrospective multicentric cohort of patients with cT1a-bN0M0 lung adenocarcinoma who underwent lobectomy or segmentectomy with systematic lymph node dissection in 10 European centers (one per country) from 2015 to 2021. Overall survival (OS), disease-free survival (DFS), and lung cancer–specific death (LCSD) between both groups were assessed in entire dataset and in dataset of histologic aggressive patterns, before and after propensity score-matching (PSM). Prognostic risk factors were analyzed using parsimonious model Cox regression. Recurrences were assessed by linearized risks. Results Lobectomy and segmentectomy were performed in 1029 (73.1%) and 377 (26.8%) patients, respectively. In total, 427 (30.3%) patients had at least 1 histologic aggressive (micropapillary or solid) pattern, and 88 patients (20.7%) underwent segmentectomy. OS, DFS, and LCSD rates were similar between patients who underwent lobectomy or segmentectomy, in both datasets, before and after PSM. In aggressive dataset, PSM, 5-year OS rates were lobectomy 88.0% (95% CI, 80.9-95.7%), segmentectomy 89.1% (95% CI, 82.2-96.6%), P = .8; 5-year DFS rates were lobectomy 79.8% (95% CI, 70.8-89.8%), segmentectomy 80.6% (95% CI, 71.6-90.6%), P = .6; and 5-year LCSD rates were lobectomy 6.0%, segmentectomy 7.8%, P = .8. Locoregional recurrence was not superior in patients who underwent segmentectomy in entire dataset (linearized risks: lobectomy 0.078, segmentectomy 0.073) and in aggressive dataset (linearized risks: lobectomy 0.036, segmentectomy 0.011) only in the unmatched cohorts. Aggressive histologic patterns impacted on only LCSD, and only when they were dominant. Conclusions Segmentectomy seems comparable to lobectomy for patients with peripheral cT1a-bN0M0 lung adenocarcinoma even in case of histologic aggressive patterns.

KW - lobectomy

KW - lung adenocarcinoma

KW - patterns

KW - prognosis

KW - segmentectomy

UR - https://www.scopus.com/pages/publications/105032802883

U2 - 10.1016/j.xjon.2026.101687

DO - 10.1016/j.xjon.2026.101687

M3 - Journal article

AN - SCOPUS:105032802883

SN - 2666-2736

JO - JTCVS Open

JF - JTCVS Open

M1 - 101687

ER -

European prognosis evaluation of early-stage lung adenocarcinoma patterns after lobectomy versus segmentectomy based on clinical stage settings

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Keywords

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