Middle lobe tumors and lymphovascular invasion as independent predictors of recurrence-free survival in stage I NSCLC.

Background: Recurrence and metastases are prevalent in lung cancer, contributing to a concerning rate of treatment failure. As a result, there is a pressing need for multivariate analyses of prognostic utility in non-small cell lung cancer (NSCLC). This study reports on the factors influencing metastasis and recurrence-free survival (RFS) in patients with clinical stage I NSCLC who have undergone anatomic lung resection.

Methods: This study included patients diagnosed with stage I NSCLC who received surgical treatment at our institution between January 2016 and December 2022. A careful examination was conducted of the patients' demographic, clinical, radiological, and histopathological data. The prognostic value of the recorded parameters was assessed according to recurrence and/or metastasis, considering RFS during follow-up assessments.

Results: Among the 616 patients included in this study, the average age was 63 ± 8.9 years, with 506 (82.1%) of patients being male. During a median follow-up period of 50.4 ± 23.7 months (ranging from 1 to 89 months), 79 patients (12.8%) experienced recurrence or metastasis, while 41 patients (6.7%) died. Multivariate analysis showed no significant differences (p > 0.05) regarding recurrence or metastasis development when considering demographic characteristics, tumor size, operation forms, histopathologic types involved, perineural and visceral pleural invasion status, and aspects of oncological treatment. Conversely, the presence of lymphovascular invasion (p < 0.003) and tumor localization in the middle node (p < 0.045) emerged as significant predictors of RFS.

Conclusion: In patients with early-stage NSCLC, the presence of lymphovascular invasion and localization of the tumor in the middle lobe are independent predictors of RFS.