Comparison of Peripheral Small-sized Lung Adenocarcinoma and Squamous Cell Carcinoma

The number of lung squamous cell carcinoma (SCC) surgeries in Japan is gradually increasing, and half or more of new lung SCC are peripheral-type. The malignant behavior of peripheral-type lung SCC has not been extensively investigated. This study compared the clinical course of peripheral lung SCC with that of adenocarcinoma.

A total of 565 patients underwent definitive pulmonary resection for primary non-small cell lung cancer from 2021 to 2024. A total of 173 patients had tumors measuring 2 cm or less in diameter and a >0.5 consolidation tumor ratio. Among these, 126 patients with peripheral lesions, cN0, and histological types of adenocarcinoma or SCC were included in this study.

This study included 100 patients with adenocarcinoma and 26 patients with SCC. Compared to patients with adenocarcinoma, those with SCC were significantly older (p=0.038), and had a higher proportion of males (p=0.060), blood cytokeratin 19 fragment levels (p=0.002), consolidation tumor ratio (p=0.005), incidence of background pulmonary interstitial shadow (p=0.015), standardized uptake values in fluorodeoxyglucose positron emission tomography/computed tomography (p=0.004), and rate of comorbidities. SCC patients tended to undergo wedge resection rather than anatomic resection. Overall (p=0.052) and recurrent-free (p=0.036) survival rates were low in patients with SCC compared to those with adenocarcinoma. Patients with SCC had a high proportion of deaths from other causes.

The prognosis of patients with peripheral SCC was poorer than that of patients with adenocarcinoma. Possible contributing factors included the tendency to avoid anatomical resection, a high rate of death from other causes, and the high malignancy of the tumors.