Clinical Utility of the 5-Point Visual Deauville Score for Preoperative Evaluation in Stage I NSCLC: A Multicenter Retrospective Study.

Reliable prognostic tools are essential for improving the management of stage I non-small cell lung cancer. While fluorodeoxyglucose positron emission tomography has proven valuable, metrics such as maximum standardized uptake value are limited by inter-institutional variability. This study evaluates the Deauville score for its clinical utility in predicting pathological invasiveness and survival outcomes. Data were retrospectively collected from 495 patients with stage I non-small cell lung cancer who underwent pulmonary resection across four institutions in Japan. Tumors were classified by a visual 5-point scale Deauville scores into groups: 1+2, 3, and 4+5. Associations between these scores, pathological invasiveness (defined as lymphatic invasion, vascular invasion, pleural invasion and/or nodal involvement), and survival outcomes were analyzed. High Deauville scores (4+5) were significantly associated with pure solid tumors (85%, P < 0.0001) and pathological invasiveness (66%, P < 0.0001). Multivariable analysis showed the Deauville score to be an independent predictor of invasiveness (odds ratio: 10.145, P < 0.0001 for scores 4+5 vs. 1+2). Survival analyses revealed poorer outcomes for patients with scores of 4+5, with a five-year recurrence-free survival of approximately 60% (P <0.0001). Even in part-solid tumors, scores of 4+5 were linked to significantly worse recurrence-free survival compared to scores of 1+2 or 3 (P <0.0001). The Deauville score provides a straightforward and consistent method to predict pathological invasiveness and survival in stage I non-small cell lung cancer. Its reliability and reproducibility across institutions highlight its potential as a valuable tool for both clinical practice and large-scale research.