Abstract / Summary
Abstract Background Outcomes after complete resection of stage I lung adenocarcinoma vary widely, and anatomical stage alone does not explain this variation. Which clinicopathological factors remain independently prognostic when analysed together is unclear. The extent of resection is particularly contested: randomised trials support limited resection in small peripheral tumours, whereas retrospective series report worse outcomes after sublobar resection in high-risk disease. Competing-risk methods are also rarely applied in single-centre series, although most deaths after resection of stage I disease are not caused by recurrence. Methods We retrospectively reviewed 184 patients with pathological stage I lung adenocarcinoma resected between January 2016 and December 2023 at a single centre; 26 were excluded. Overall and disease-free survival were estimated by the Kaplan-Meier method and compared by log-rank test. Cox proportional hazards models were fitted for each endpoint, containing histological grade, lymphovascular invasion, tumour size, extent of resection, age, sex and, for overall survival, adjuvant therapy. Recurrence was additionally analysed with the Aalen-Johansen estimator and a Fine-Gray model, treating death without recurrence as the competing event. Results A total of 158 patients were analysed; 118 underwent lobar and 40 sublobar resection. Median follow-up was 84.9 months. Recurrence occurred in 34 patients (21.5%) and 41 (25.9%) died. 5-year overall and disease-free survival were 79.2% and 64.9%. Lymphovascular invasion was independently associated with worse overall survival (hazard ratio 3.24, 95% confidence interval 1.63 to 6.45) and disease-free survival (2.47, 1.42 to 4.29), whereas histological grade and extent of resection were not. Twenty-six of 41 deaths (63.4%) occurred without recurrence. Cumulative incidence of recurrence at five years was 20.3% versus a Kaplan-Meier estimate of 22.6%. Half of all recurrences occurred beyond 24 months. Conclusions Analysed together, lymphovascular invasion was the only factor independently associated with both recurrence and death. These data align with the randomised evidence rather than with series favouring lobectomy in high-risk disease. Most deaths occurred without recurrence, which affects how recurrence risk should be estimated, and half of all recurrences occurred beyond two years, arguing against surveillance limited to the early postoperative period. Confirmation in multicentre cohorts, and prospective collection of cause-of-death and pulmonary function data, are required. Trial registration Not applicable.