Comparison of oncological outcomes between adenocarcinoma and squamous cell carcinoma after sublobar resection for T1a/bN0M0 non-small cell lung cancer: a propensity score-matched SEER study
Year: 2026
Type: article
Abstract: Background: Sublobar resection is increasingly used for selected patients with early-stage non-small cell lung cancer (NSCLC). However, whether adenocarcinoma (ADC) and squamous cell carcinoma (SCC) have comparable survival outcomes after sublobar resection remains uncertain, particularly when competing causes of death are considered. This study aimed to compare survival outcomes between ADC and SCC after sublobar resection, incorporating tumor size stratification and competing-risk analyses. Methods: Patients with one primary T1a/bN0M0 NSCLC who underwent segmentectomy (SEG) or wedge resection (WR) between 2004 and 2022 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared between ADC and SCC using propensity score matching (PSM), Kaplan-Meier analysis, and Cox regression, with hazard ratios (HRs) and 95% confidence intervals (CIs) reported. Tumor size-stratified analyses were also performed. Cumulative incidence functions (CIFs), Gray's test, and Fine-Gray regression were used to evaluate lung cancer-specific death (LCSD) and other-cause death (OCD) as competing events, with subdistribution hazard ratios (sHRs) reported. Exploratory comparisons of SEG and WR were conducted within each histologic subtype. Results: Among 4,198 patients (3,066 ADC and 1,132 SCC), 1,129 patients remained in each group after 1:1 PSM with well-balanced baseline characteristics. SCC was independently associated with poorer OS than ADC (adjusted HR, 1.34; 95% CI, 1.20-1.51; P<0.001), with consistent associations in both tumor size subgroups. LCSS did not differ significantly after adjustment (adjusted HR, 0.95; 95% CI, 0.79-1.15; P=0.62) or within either size subgroup. CIF analysis showed no significant difference in LCSD (Gray's P=0.10), whereas the CIF of OCD was significantly higher in SCC (Gray's P<0.001). Fine-Gray regression yielded consistent findings: SCC was not significantly associated with LCSD (adjusted sHR, 0.85; 95% CI, 0.71-1.02; P=0.09) but was associated with a higher subdistribution hazard of OCD (adjusted sHR, 1.66; 95% CI, 1.44-1.91; P<0.001). These competing-risk patterns were consistent in both tumor size subgroups. Exploratory analyses showed no consistent adjusted survival advantage of SEG over WR within either histologic subtype. Conclusions: Among patients with T1a/bN0M0 NSCLC undergoing sublobar resection, SCC was associated with poorer OS than ADC, consistently across tumor size subgroups. In contrast, neither LCSS nor LCSD was significantly worse in SCC, whereas the incidence of OCD was higher; these patterns were also consistent across tumor size subgroups. The poorer overall prognosis associated with SCC should therefore be interpreted in the context of competing mortality rather than lung cancer-specific mortality alone.
Source: Journal of Thoracic Disease
Institutions: Taizhou Fourth People's Hospital, Jiangsu Province Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223314194