Prospective cohort study of Suture-Line recurrence and clinical outcomes in stage 1A Non-Small cell lung cancer

Abstract

Background

Increased lung cancer screening has made early-stage non-small-cell lung cancer (NSCLC) more common, with lung-sparing surgery as the standard curative treatment. Our study evaluated patients who underwent surgery for pathologic stage 0/1A NSCLC and presented with suture-line recurrences—either isolated or with additional findings—and compared these patients to other types of recurrence.

Methods

We analyzed 653 patients with pathologic stage 0/1A NSCLC from the IELCART cohort (2016–2023). Recurrences were categorized by the presence or absence of suture line involvement, and survival outcomes were assessed.

Findings

Among 653 patients (median age 69), 44 (11.3 %) experienced recurrences, including 22 suture-line recurrences. Sublobar resections (19/22 vs. 11/22, p = 0.01) and smaller margins (8 mm vs. 20 mm, p < 0.001) were more frequent in patients with suture-line recurrences. Of the 22 suture-line recurrences, 13 were isolated, and 9 had additional findings. Isolated recurrences were diagnosed later (31.0 vs. 14.0 months, p = 0.01) and treated with surgery (6/13) or radiotherapy (7/13), both well-tolerated. Patients with isolated suture-line recurrences demonstrated better survival outcomes compared to all other recurrence types (overall survival: 72.0 % vs. 45.7 %, p = 0.02; lung cancer-specific survival: 90.0 % vs. 76.1 %, p = 0.19).

Interpretation

Recurrences after stage 0/1A lung cancer surgery are rare, with half involving the suture line. Suture-line recurrences arise around two years post-surgery, often following sublobar resections with resection margins under 1 cm. For isolated suture-line recurrences, treatment with either radiotherapy and completion surgery were effective, yielding comparable outcomes and improved survival compared to any other recurrence types.