Adjuvant chemotherapy for high-risk pathological stage I non-small cell lung cancer

Abstract Background This study aims to investigate the efficacy of adjuvant chemotherapy for pathological stage I non-small cell lung cancer (NSCLC) with high risk for recurrence. Methods Prospectively collected data from 1,278 patients with pathological stage I NSCLC according to eighth edition staging guidelines undergoing lobectomy were retrospectively analyzed. Factors associated with high risk for recurrence were determined using the multivariable Cox proportional hazards model for recurrence-free survival (RFS). Survival was compared between patients who received adjuvant chemotherapy and those who did not. Results In multivariable analysis, age ( > 70 y), invasive component size (>2 cm), visceral pleural invasion, lymphatic invasion, and vascular invasion were identified as independent factors for RFS. In patients with high risk factors for recurrence such as pathological T1c/T2a or lymphovascular invasion (high-risk group; n = 641), adjuvant chemotherapy resulted in significantly longer RFS and overall survival (n = 222; 5-y RFS, 81.4%; 5-y overall survival, 92.7%) than in patients who did not receive adjuvant chemotherapy (n = 418; 5-y RFS, 73.8%; P = 0.023; 5-y overall survival, 81.7%; P Conclusions Adjuvant chemotherapy may improve survival in patients with pathological stage I NSCLC who have factors associated with high risk for recurrence, such as pathological T1c/T2a or lymphovascular invasion.