Predictors of Long-Term Survival of Thoracoscopic Lobectomy for Stage IA Non-Small Cell Lung Cancer: A Large Retrospective Cohort Study

SIMPLE SUMMARY: Lung cancer is a serious and, in many cases, fatal disease. If detected early, it can often be treated successfully. The best treatment results are obtained by a surgical operation which includes removing the part of the lung with the tumor and the excision of the lymph nodes from the chest. The most commonly used measure of treatment effectiveness is the five-year survival. The aim of this study was to identify factors related to 5-year survival after lung cancer surgery. We found that older age, male sex, chronic obstructive pulmonary disease and prolonged postoperative air leak were related to a lower 5-year survival rate. We also found that more accurate lymph node removal was related to a higher 5-year survival rate. These findings provide valuable insights for clinical practice and may contribute to improving the quality of treatment of early-stage NSCLC. ABSTRACT: The standard of care for patients with early-stage non-small cell lung cancer (NSCLC) is anatomical lung resection with lymphadenectomy. This multicenter, retrospective, cohort study aimed to identify predictors of 5-year survival in patients after thoracoscopic lobectomy for stage IA NSCLC. The study included 1249 patients who underwent thoracoscopic lobectomy for stage IA NSCLC between 17 April 2007, and December 28, 2016. The 5-year survival rate equaled 77.7%. In the multivariate analysis, higher age (OR, 1.025, 95% CI: 1.002 to 1.048; p = 0.032), male sex (OR, 1.410, 95% CI: 1.109 to 1.793; p = 0.005), chronic obstructive pulmonary disease (OR, 1.346, 95% CI: 1.005 to 1.803; p = 0.046), prolonged postoperative air leak (OR, 2.060, 95% CI: 1.424 to 2.980; p < 0.001) and higher pathological stage (OR, 1.271, 95% CI: 1.048 to 1.541; p = 0.015) were related to the increased risk of death within 5 years after surgery. Lobe-specific mediastinal lymph node dissection (OR, 0.725, 95% CI: 0.548 to 0.959; p = 0.024) was related to the decreased risk of death within 5 years after surgery. These findings provide valuable insights for clinical practice and may contribute to improving the quality of treatment of early-stage NSCLC.