| ObjectiveLung cancer is one of the malignant tumors with high incidence and mortality rate worldwide.Among them,non-small cell lung cancer(NSCLC)accounts for more than 80%of the total number of lung cancer patients,and lung squamous cell carcinoma(SCC)is one of the major pathological types of non-small cell lung cancer,and it accounts for nearly 30%of all lung cancers.Previous studies have focused on the optimal surgical options for nonsmall cell lung cancer and lung adenocarcinoma.The aim of this study was to perform a comparative analysis of survival time after segmentectomy,wedge resection,or lobectomy in patients with clinical stage IA(c Stage IA)lung squamous cell carcinoma using the SEER(Surveillance,Epidemiology,and End Results)database to provide the choice of surgical approach for c Stage IA SCC.Also,this study analyzed the independent factors influencing survival outcomes in patients with c Stage IA SCC treated with surgery,which will help to further understand the reasons for the differences in survival outcomes of patients with c Stage IA SCC and thus provide a theoretical basis for their prognostic assessment.MethodsWe enrolled 4316 patients who had c Stage IA SCC who underwent surgery from the SEER database,and general information(marital status,age,sex,and race),tumor pathological characteristics(location,degree of differentiation,and tumor diameter),treatment information,follow-up time and survival outcome were extracted from the included patients.Patients were classified into three levels according to tumor size(≤1.0cm,1.1-2.0cm and 2.1-3.0cm).To eliminate potential biases of included patients,the propensity score matching(PSM)method was used.The Kaplan-Meier analysis was performed to compare overall survival(OS)and lung cancer-specific survival(LCSS)between the different surgery groups in this study.In addition,Cox proportional risk regression models was conducted to recognize the independent risk factors for OS and LCSS in patients with c Stage IA lung squamous cell carcinoma.ResultsKaplan-Meier analyses revealed no statistical differences in the rates of OS and LCSS for patients with c Stage IA SCC who had wedge resection and segmentectomy.In patients with tumors ≤1.0cm,LCSS favored lobectomy compared to segmentectomy,but a similar survival rate was obtained for wedge resection and lobectomy.For patients with tumors sized 1.1 to 2.0cm,lobectomy had improved OS and LCSS compared to the segmentectomy or wedge resection groups,with the exception of a similar OS for lobectomy and segmentectomy.For tumors sized 2.1 to 3.0cm,lobectomy had a higher rate of OS or LCSS than wedge resection or segmentectomy,except that lobectomy conferred a similar LCSS compared to segmentectomy.Multivariable Cox analyses showed that patients aged ≥75and tumor sizes of >2 to ≤3cm were potential risk factors for OS and LCSS,while lobectomy and first malignant primary indicator were considered protective factors.The Cox proportional analysis also confirmed that male patients aged ≥65 to <75 were independent prognostic factors that are indicative of a worse OS.ConclusionThe tumor size can influence the surgical procedure recommended for individuals with c Stage IA lung SCC.For patients with tumors ≤1.0cm,lobectomy is the recommended approach,and wedge resection or segmentectomy might be an alternative for those who cannot tolerate lobectomy if adequate surgical margin is achievable and enough nodes are sampled.For tumors >1.0 to ≤3.0cm,lobectomy showed better survival outcomes than sublobar resection.Our findings require further validation by randomized controlled trial(RCT)or other evidence. |
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