Imaging appearances, CT evolution patterns, and surgical prognosis of stage I lung squamous cell carcinoma.

OBJECTIVES: Lung squamous cell carcinoma (LSCC) is a prevalent subtype of lung cancer characterized by a high mortality rate. Early diagnosis and preoperative prognostic prediction are critical for effective patient stratification, guiding clinical management, and ultimately improving patient outcomes. This study aims to investigate the imaging appearances, dynamic changes during follow-up CT, and surgical prognosis of stage I LSCC. METHODS: A retrospective analysis was performed on 363 patients with central type (c-LSCC) and 310 patients with peripheral type (p-LSCC). The imaging features of c-LSCC and p-LSCC were first established. Subsequently, the dynamic changes of both types during follow-up CT scans were assessed and compared. Finally, the surgical prognosis for each LSCC type were evaluated. RESULTS: The c-LSCC was categorized into two types: type I (endobronchial lesions; 48.76%, 177/363) and type II (hilar nodule or mass; 51.24%, 186/363). Four CT signs were identified: localized bronchial wall thickening (21.49%, 78/363), soft tissue in the bronchial lumen (9.09%, 33/363), bronchial cast shadows (BCS) (76.03%, 276/363), and hilar nodule or mass (51.24%, 186/363). By comparison, the p-LSCC was classified into three categories: type I (solid nodule; 93.22%, 289/310), type II (thin-walled cystic nodule; 6.13%, 19/310), and type III (subsolid nodule; 0.65%, 2/310). Notably, c-LSCC and p-LSCC showed distinct CT evolution patterns. The c-LSCC advanced from endobronchial growth to airway obstruction and BCS development, ultimately forming a hilar mass. While the p-LSCC showed progressive enlargement with malignant features. Stage I c-LSCC had worse disease-free survival (DFS) and overall survival (OS) than p-LSCC (all p < 0.05). Survival analysis revealed that a CT score of BCS ≥ 4 and obstructive pneumonia were independent predictors of poor outcomes for both DFS and OS in patients with c-LSCC (p < 0.05). Conversely, a history of previous malignancy and perifocal fibrosis predicted unfavorable prognosis for both DFS and OS in patients with p-LSCC (p < 0.05). CONCLUSION: Early-stage LSCC demonstrates distinct imaging characteristics, CT evolution patterns, and surgical prognosis between central and peripheral subtypes, informing early diagnosis and personalized management strategies.