Association of resection type, nodal evaluation, and survival in early-stage lung squamous cell carcinoma

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Background: While recent trials suggest sublobar resection is non-inferior to lobectomy for stage IA non-small cell lung cancer (NSCLC), patients with squamous cell carcinoma (SCC) were underrepresented. We aimed to evaluate outcomes of sublobar resection versus lobectomy in early-stage SCC. Methods: Using the National Cancer Database (NCDB; 2010–2022), we identified patients >18 years with stage IA SCC. We compared demographics, tumor characteristics, perioperative outcomes, nodal evaluation, and survival between patients undergoing lobectomy or sublobar resection. Overall survival was evaluated using Kaplan-Meier analysis and Cox proportional hazards regression, with sequential adjustment for lymph node evaluation to assess its influence on survival estimates. Results: Among 207 patients, 63% underwent lobectomy and 37% sublobar resection. The sublobar group was older (72.0 vs. 69.2 years, P=0.006); other factors were similar. Fewer lymph nodes were examined in sublobar cases (1 vs. 9, P<0.001). Although not statistically significant, survival trended lower with sublobar resection (hazard ratio 1.57, 95% confidence interval: 0.91–2.72, P=0.10; median survival 4.1 vs. 8.6 years). Conclusions: Although overall survival appeared higher following lobectomy, this association was attenuated after adjustment for lymph node evaluation and was no longer statistically significant. These findings highlight the importance of adequate nodal assessment and should be considered hypothesis-generating.

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