Comparison of Outcomes Between Ablation and Lobectomy in Stage IA Non‐Small Cell Lung Cancer: A Retrospective Multicenter Study

Background and Objective Image‐guided thermal ablation (IGTA) has been increasingly used in patients with stage IA non‐small cell lung cancer (NSCLC) without surgical contraindications, but its long‐term outcomes compared to lobectomy remain unknown. This study aims to evaluate the long‐term outcomes of IGTA versus lobectomy and explore which patients may benefit most from ablation. Methods After propensity score matching, a total of 290 patients with stage IA NSCLC between 2015 and 2023 were included. Progression‐free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. A Markov model was constructed to evaluate cost‐effectiveness. Finally, a radiomics model based on preoperative computed tomography (CT) was developed to perform risk stratification. Results After matching, the median follow‐up intervals were 34.8 months for the lobectomy group and 47.2 months for the ablation group. There were no significant differences between the groups in terms of 5‐year PFS (hazard ratio [HR], 1.83; 95% CI, 0.86–3.92; p = 0.118) or OS (HR, 2.44; 95% CI, 0.87–6.63; p = 0.092). In low‐income regions, lobectomy was not cost‐effective in 99% of simulations. The CT‐based radiomics model outperformed the traditional TNM model (AUC, 0.759 vs. 0.650; p < 0.01). Moreover, disease‐free survival was significantly lower in the high‐risk group than in the low‐risk group ( p = 0.009). Conclusion This study comprehensively evaluated IGTA versus lobectomy in terms of survival outcomes, cost‐effectiveness, and prognostic prediction. The findings suggest that IGTA may be a safe and feasible alternative to conventional surgery for carefully selected patients.