{"entity":{"id":"jcog0802","kind":"trial","name":"JCOG0802 / WJOG4607L","aka":["JCOG0802","WJOG4607L"],"tldr":"The trial that showed taking out one segment of a lung, rather than a whole lobe, is enough for a small peripheral lung cancer, and that the smaller operation leaves people alive longer.","summary":"JCOG0802/WJOG4607L randomised 1,106 patients in Japan with a peripheral non-small-cell lung cancer of 2 cm or less to segmentectomy or lobectomy, with overall survival as the primary endpoint and a non-inferiority design. Segmentectomy not only met non-inferiority but was superior for overall survival, which was the surprise: the smaller operation preserves lung function, and the deaths it prevents are from second primary cancers and other causes rather than from the index tumour.\n\nThe 2024 supplemental analysis in Lancet Respiratory Medicine looked at the 553 patients (50 percent) whose tumours were radiologically pure-solid, the group thought most likely to need the larger operation. After a median 7.3 years, five-year overall survival was 92.4 percent after segmentectomy against 86.1 percent after lobectomy (hazard ratio 0.64, 95 percent confidence interval 0.41 to 0.97, log-rank p=0.033), with 38 deaths against 55.\n\nRead with CALGB 140503, which randomised 697 patients in North America to sublobar resection or lobectomy and found disease-free survival non-inferior, the two trials moved sublobar resection from a compromise for the unfit to a standard option for small peripheral tumours. What they do not answer is which sublobar operation, segmentectomy or wedge, and how wide a margin.","status":"positive","asOf":"2026-09-25","links":[{"label":"JCOG0802/WJOG4607L pure-solid supplemental analysis (Lancet Respiratory Medicine 2024)","url":"https://doi.org/10.1016/S2213-2600(23)00382-X"},{"label":"UMIN Clinical Trials Registry UMIN000002317","url":"https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000002809"}],"tags":[],"related":[],"cancers":["resectable-nsclc","lung-adenocarcinoma"],"sections":[],"technologies":["robotic-surgery"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["curative-intent","lobectomy","segmentectomy","minimally-invasive-surgery"],"trials":["calgb-140503"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"phase":"3","setting":"Peripheral non-small-cell lung cancer 2 cm or smaller with a consolidation-to-tumour ratio above 0.5: segmentectomy versus lobectomy, with overall survival as the primary endpoint and non-inferiority as the design","sponsor":"Japan Clinical Oncology Group and West Japan Oncology Group","result":"Segmentectomy was superior to lobectomy for overall survival; in the pure-solid subgroup five-year overall survival was 92.4 against 86.1 percent (hazard ratio 0.64).","yearReported":2022,"enrolledBasis":"registry","outcomes":[{"endpoint":"Overall survival at 5 years (radiologically pure-solid subgroup)","unit":"%","arms":[{"name":"Segmentectomy","n":279,"value":92.4},{"name":"Lobectomy","n":274,"value":86.1}],"hr":0.64,"ci":[0.41,0.97],"p":"0.033","source":"https://doi.org/10.1016/S2213-2600(23)00382-X"}],"replication":"CALGB 140503 (Alliance) reached the same conclusion for sublobar resection in a North American population with a disease-free survival endpoint."},"route":"/trials/jcog0802/","neighbours":{"cancer":[{"id":"lung-adenocarcinoma","kind":"cancer","name":"Adenocarcinoma of the lung","route":"/cancers/lung-adenocarcinoma/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"resectable-nsclc","kind":"cancer","name":"Resectable stage I to III non-small-cell lung cancer","route":"/cancers/resectable-nsclc/"}],"technology":[{"id":"robotic-surgery","kind":"technology","name":"Robotic & minimally invasive surgery","route":"/technologies/robotic-surgery/"}],"term":[{"id":"curative-intent","kind":"term","name":"Curative intent vs palliative intent","route":"/terms/curative-intent/"},{"id":"lobectomy","kind":"term","name":"Lobectomy","route":"/terms/lobectomy/"},{"id":"minimally-invasive-surgery","kind":"term","name":"Minimally invasive surgery (laparoscopic, robotic, VATS)","route":"/terms/minimally-invasive-surgery/"},{"id":"segmentectomy","kind":"term","name":"Segmentectomy (sublobar resection)","route":"/terms/segmentectomy/"}],"trial":[{"id":"calgb-140503","kind":"trial","name":"CALGB 140503 (Alliance)","route":"/trials/calgb-140503/"},{"id":"stars-rosel","kind":"trial","name":"STARS and ROSEL pooled analysis","route":"/trials/stars-rosel/"}]}}