Tumor Location Is an Independent Prognostic Factor in Completely Resected Pathological Stage I Non-Small Cell Lung Cancer: A Multicenter Retrospective Study

Abstract

Simple Summary Early detection and curative-intent surgery are crucial for improving survival rates in patients with early-stage non-small cell lung cancer (NSCLC). However, even after complete tumor resection in patients with pathological stage I NSCLC, recurrence rates and overall survival remain unfavorable. There is growing evidence suggesting that the location of the primary tumor, nodal upstaging, certain genetic mutations, and histological characteristics have been found to be more prevalent in tumors located in specific lung regions. To address this research gap, we conducted a multicenter retrospective study in Taiwan to explore the independent prognostic significance of tumor location in patients with completely resected pathological stage I NSCLC. The results suggest that patients with NSCLC located in the lower lobe, especially those that are histologically classified as IASLC Grade 3, may require additional attention and interventions to improve outcomes. These findings have implications for personalized treatment strategies and the identification of high-risk patients who may benefit from closer surveillance or adjuvant therapies.Abstract Previous studies suggested that the location of the primary tumor in non-small cell lung cancer (NSCLC) is associated with clinical features and prognosis, but results are conflicting. The purpose of this study was to explore tumor location as an independent risk factor of survival for patients with completely resected pathological stage I NSCLC. This was a multicenter retrospective study conducted in Taiwan. Included patients were diagnosed with stage I NSCLC and had undergone primary tumor resection. Variables including tumor location, pathological stage, histological differentiation, and International Association for the Study of Lung Cancer (IASLC) grade were evaluated for predictive ability for disease-free survival (DFS) and overall survival (OS). A total of 208 patients were included, with 123 (59.1%) patients having a primary tumor in the upper and middle lobes. The median duration of follow-up for survivors was 60.5 months. Compared to patients with IASLC Grade 3 disease, patients with Grade 1 disease had significantly longer DFS. Tumor location and IASLC grade were independent predictors for OS in multivariate analysis. Specifically, patients with NSCLC in the lower lobe and patients who are histologically classified as IASLC Grade 3 may have poorer prognosis and require greater attention to improve outcomes.