Prognostic ımpact of vascular, lymphatic, and perineural ınvasion in surgically resected, non-adjuvantly treated stage IA non-small-cell lung cancer: a retrospective cohort study.

Surgical treatment can achieve a cure in stage IA non-small-cell lung cancer (NSCLC). Although invasion of vascular, lymphatic, or perineural structures does not alter TNM staging, such features are sometimes considered when recommending adjuvant therapy. This study aimed to evaluate the impact of these invasion types on overall survival (OS) and disease-free survival (DFS) in stage IA NSCLC patients who did not receive adjuvant treatment. A total of 402 patients with pathological stage T1N0M0 NSCLC who underwent anatomical lung resection between January 2014 and December 2019 were retrospectively analyzed. Final staging was performed according to the 8th edition of the TNM classification. Pathology reports and follow-up data were reviewed. Demographic features, surgical details, postoperative complications, and tumor invasion patterns were examined in relation to OS and DFS using Jamovi (v2.5.3.0). In multivariable analysis, older age (HR 1.03, 95% CI 1.00-1.06, p = 0.05), male sex (HR 1.81, 95% CI 1.10-2.98, p = 0.01), and postoperative complications (HR 1.64, 95% CI 1.12-2.40, p = 0.01) independently predicted lower OS. While individual invasion types were not significantly associated with OS, their co-occurrence predicted poorer OS (HR 4.06, p = 0.05) and DFS (HR 12.74, p = 0.001). In subgroup analyses, lymphatic invasion was linked to reduced OS in male patients (HR 1.46, p = 0.04), while lymphatic and vascular invasion both negatively affected OS in squamous cell carcinoma (HR 1.72 and 1.98, respectively). When all three invasion types were present, prognosis worsened markedly in stage IA NSCLC. Sex- and histology-based risk assessment may help guide postoperative treatment decisions.