OBJECTIVES Clinical decisions for NSCLC patients are often based on TNM stage, which does not account for different histological subtype. Whether histological subtype affects survival still remains unclear. The main objective of this study was to determine the extent to which the survival outcomes of patients with early-stage NSCLC differ by histological subtype. MATERIAL AND METHODS Retrospective cohort study of SEER data base. Patients with stage IA and IB NSCLC that underwent surgery with lymph node dissection were included. The primary outcome was the time to death. Cox proportional hazards models were used to identify risk factors associated with overall survival (OS). The secondary outcome was the time to death from lung cancer. A Cox model and a Fine-Gray subdistribution hazards model in which death from causes other than lung cancer was considered a competing risk event were used to identify risk factors for death from lung cancer. RESULTS Analysis of the SEER database identified 28,584 NSCLC patients, of whom 19,750 (69 %) had adenocarcinoma and 8834 (31 %) had squamous cell carcinoma. In the multivariate for OS, older age (p < 0.001), male gender (p < 0.001), pneumonectomy (p < 0.001), larger tumor size (p < 0.001), squamous cell carcinoma (p < 0.001) not being Hispanic or Asian were associated with increased risk of death. In the competing risk model, older age (p < 0.001), male gender (p < 0.001), pneumonectomy (p < 0.001), larger tumor size (p < 0.001), and squamous cell carcinoma (p < 0.001) were was associated with an increased risk of death from lung cancer. CONCLUSION This study suggests that among patients with stage I NSCLC, those with squamous histology have a higher risk of mortality than those with adenocarcinoma histology taking into account competing risks.

中文翻译：

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具有不同组织学类型的非小细胞肺癌患者手术后的生存差异。

目的NSCLC患者的临床决策通常基于TNM分期，这不能解释不同的组织学亚型。组织学亚型是否影响生存仍不清楚。这项研究的主要目的是确定早期NSCLC患者的生存结局在不同组织学亚型方面的差异。材料与方法SEER数据库的回顾性队列研究。包括接受了淋巴结清扫术的IA和IB NSCLC期患者。主要结果是死亡时间。使用Cox比例风险模型来识别与总生存期（OS）相关的危险因素。次要结果是死于肺癌的时间。使用Cox模型和Fine-Gray子分布危害模型（其中将非肺癌原因引起的死亡视为竞争风险事件）来识别肺癌死亡的风险因素。结果对SEER数据库的分析确定了28584例NSCLC患者，其中19750例（69％）患有腺癌，8834例（31％）患有鳞状细胞癌。在OS多因素分析中，年龄较大的患者（p <0.001），男性（p <0.001），肺切除术（p <0.001），较大的肿瘤大小（p <0.001），鳞状细胞癌（p <0.001）不是西班牙裔或亚洲人与死亡风险增加相关。在竞争性风险模型中，年龄较大（p <0.001），性别（p <0.001），肺切除术（p <0.001），较大的肿瘤大小（p <0.001）和鳞状细胞癌（p <0）。001）与肺癌死亡风险增加相关。结论这项研究表明，考虑到竞争风险，在I期NSCLC患者中，具有鳞状组织学的患者比具有腺癌组织学的患者具有更高的死亡风险。