Risk factors associated with locoregional recurrence following pulmonary segmentectomy for clinical stage IA1-2 NSCLC: a real clinical practice analysis

Abstract OBJECTIVES The oncological role of anatomic segmentectomy in early-stage non-small cell lung cancer (NSCLC) remains under active investigation. We sought to identify predictors of recurrence following segmentectomy in patients with clinical stage IA1–2 NSCLC. METHODS We retrospectively analysed consecutive patients who underwent segmentectomy for clinical stage IA1–2 pathologically confirmed NSCLC between 2017 and 2024. Event-free survival (EFS), overall survival (OS), and recurrence patterns were assessed. Cox regression and competing risk models were applied to determine factors associated with adverse outcomes. RESULTS A total of 287 patients were included. Four-year OS and EFS were 80% (95% CI, 73–87) and 69.5% (95% CI, 61–77), respectively. Recurrence occurred in 31 patients (10.8%), predominantly loco-regional (n = 26, 9.1%). Patients with resection margins <5 mm had significantly higher rates of loco-regional recurrence compared with those with wider margins (20.3% vs 5.8%, p < 0.001). On competing risk analysis, a short margin (<5 mm) was independently associated with recurrence (p = 0.009). Poorer EFS was also observed in patients with hypermetabolic tumours on PET (SUVmax >2.5 vs ≤ 2.5: 60% [95% CI, 48–70] vs 81% [95% CI, 69–89]; p = 0.0001) and in pure solid tumours compared with those with a subsolid component (61% [IQR, 45–74] vs 73% [IQR, 62–81]; p = 0.039). CONCLUSIONS Adequate resection margins are critical to reduce loco-regional recurrence after segmentectomy for stage IA NSCLC. PET avidity and tumour morphology further stratify recurrence risk. Careful preoperative planning and tailored surgical strategies are essential to ensure oncologically sound resections.