Comparative outcomes of lobectomy versus sublobar resection for GGO-dominant early-stage NSCLC: A meta-analysis of published and reconstructed individual patient data

The optimal surgical approach for ground-glass opacity (GGO)-dominant early-stage non-small cell lung cancer (NSCLC) remains uncertain. This systematic review and meta-analysis aimed to compare outcomes between lobectomy and sublobar resection in this population. Eligible studies included adults with clinical stage I NSCLC characterized by GGO-dominant nodules (consolidation-to-tumor ratio <0.5) undergoing lobectomy or sublobar resection. Four databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL) were searched from January 2000 to April 2025. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Both aggregate data and reconstructed individual patient data (IPD) were analyzed. Random-effects models pooled hazard ratios (HRs), and stratified Cox models evaluated IPD. Eight studies met inclusion criteria. The pooled HR for overall survival was 1.01 (95% CI: 0.77–1.32; p = 0.93; I 2 = 0%), indicating no significant difference between lobectomy and sublobar resection. For recurrence-free survival, the HR was 1.42 (95% CI: 0.87–2.33; p = 0.16). Stratified IPD analyses (n = 2271 for overall survival; n = 1621 for recurrence-free survival) yielded similar findings, with non-significant differences between surgical approaches. Most studies had moderate overall risk of bias due to confounding and selective reporting. All included studies were observational, and assumptions in reconstructed IPD analyses may affect interpretation. Sublobar resection, particularly segmentectomy, appears comparable to lobectomy for GGO-dominant early-stage NSCLC. Randomized trials are needed to confirm these findings.