Prognostische analyse van histologische typen bij 2-3 cm longcarcinoom naar chirurgische procedure

BACKGROUND: Sublobar resection is increasingly used for 2-3 cm non-small cell lung cancer (NSCLC), but its survival benefit compared to lobectomy for intermediate- and high-risk histological types (acinar, papillary, micropapillary, and solid) remains unclear. This study compares oncological outcomes of 2 surgical procedures in node-negative, non-metastatic NSCLC patients with such histological types. METHODS: We conducted a retrospective analysis using data from the Surveillance, Epidemiology, and End Results database of the United States National Cancer Institute from 2004 to 2022. Patients with 2-3 cm pN0M0 histologically recorded as acinar, papillary, micropapillary, or solid carcinoma, who were treated with either sublobar resection or lobectomy, were included. We compared overall survival ​by histological type. RESULTS: Among 1,458 patients, univariate and multivariate analyses identified age, sex, surgical procedure, and pleural invasion as independent prognostic factors. Stratified analysis by histological type suggested that sublobar resection was associated with worse survival in patients with solid (p < .001) and acinar carcinomas (p < .001), while pleural invasion significantly affected overall survival only in acinar carcinoma (p < .001). CONCLUSIONS: For patients with stage ​pN0M0​ non-small cell lung cancer measuring 2-3 cm, the specific histological type plays a critical role in guiding the choice of surgical extent and in evaluating the prognostic implications of pleural invasion. Individualized treatment based on histological type is essential to optimize outcomes.