Predictors of Recurrence Following Sublobar Resection for Clinical T1N0M0 Non-Small Cell Lung Cancer.

Abstract

Background: Recurrence is a significant concern after sublobar resection for clinical T1N0M0 lung cancer. Identifying modifiable risk factors is essential for improving oncologic outcomes.

Objective: This review examines recurrence risk factors following sublobar resection, focusing on disease stage, tumor characteristics, and surgeon-related factors.

Methods: Data from randomized trials and retrospective studies were analyzed to assess the impact of tumor biology, stage, surgical margins, and lymph node dissection on recurrence.

Results: Recurrence is influenced by tumor stage, biology, and surgical technique. While tumor characteristics and stage are non-modifiable, inadequate surgical margins and incomplete nodal dissection significantly increase recurrence risk. A margin of ≥1 cm or equal to the tumor diameter is associated with lower recurrence rates. Systematic nodal dissection enhances staging accuracy and informs adjuvant therapy. Although sublobar resection is non-inferior to lobectomy in select cases, inadequate margins and suboptimal nodal assessment elevate recurrence risk.

Conclusion: Surgical margins and lymph node dissection are the most critical modifiable risk factors for recurrence. To optimize long-term survival, adequate margins and systematic nodal evaluation should be prioritized. Further research is needed to assess the role of completion lobectomy or adjuvant therapy, particularly in patients with multiple high-risk features.