{"doi":"10.21037/jtd-23-989","title":"Factors associated with incomplete resection for large, locally invasive non-small cell lung cancer","abstract":"Background: Large, node-negative but locally invasive non-small cell lung cancer (NSCLC) is associated with increased perioperative risk but improved survival if a complete resection is obtained. Factors associated with positive margins in this population are not well-studied. Methods: We performed a retrospective cohort study using National Cancer Database (NCDB) for adult patients with >5 cm, clinically node-negative NSCLC with evidence of invasion of nearby structures [2006-2015]. Patients were classified as having major structure involvement (azygous vein, pulmonary artery/vein, vena cava, carina/trachea, esophagus, recurrent laryngeal/vagus nerve, heart, aorta, vertebrae) or chest wall invasion (rib pleura, chest wall, diaphragm). Our primary outcome was to evaluate factors associated with incomplete resection (microscopic: R1, macroscopic: R2). Kaplan-Meier analysis and cox multivariable regression models were used to evaluate overall survival (OS), 90-day mortality, and factors associated with positive margins. Results: Among 2,368 patients identified, the median follow-up was 33.8 months [interquartile range (IQR), 12.6-66.5 months]. Most patients were white (86.9%) with squamous cell histology (47.3%). Major structures were involved in 26.4% of patients and chest wall invasion was seen in 73.6%. Four hundred and seventy-eight patients (20.2%) had an incomplete resection. Multivariable analysis revealed that black race [hazard ratio (HR) 1.568, 95% confidence interval (CI): 1.109-2.218] and major structure involvement (HR 1.412, 95% CI: 1.091-1.827) was associated with increased risk of incomplete resection and surgery at an academic hospitals (HR 0.773, 95% CI: 0.607-0.984), adenocarcinoma histology (HR 0.672, 95% CI: 0.514-0.878), and neoadjuvant chemotherapy (HR 0.431, 95% CI: 0.316-0.587) were associated with decreased risk of incomplete resection. The 5-year OS was 43.7% in the entire cohort and 28.8% in patients with positive margins and 47.5% in patients with an R0 resection. Positive margin was also associated with a significantly higher 90-day mortality rate (9.9% versus 6.7%). Conclusions: For patients with large, node-negative NSCLC invading nearby structures, R0 resection portends better survival. Treatment at academic centers, adenocarcinoma histology, and receipt of neoadjuvant chemotherapy are associated with R0 resection in this high-risk cohort.","journal":"Journal of Thoracic Disease","year":2024,"id":471028,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.516,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":492362,"name":"Zhizhou Yang","orcid":"0000-0002-0921-3606","position":1,"is_corresponding":false},{"id":446033,"name":"Brendan T. Heiden","orcid":"0000-0002-0116-7377","position":2,"is_corresponding":false},{"id":426293,"name":"Pamela Samson","orcid":"0000-0003-2448-2123","position":3,"is_corresponding":false},{"id":1305653,"name":"Daniel Morgensztern","orcid":"0000-0003-4349-2028","position":4,"is_corresponding":false},{"id":299218,"name":"Saiama N. Waqar","orcid":"0000-0002-7069-5456","position":5,"is_corresponding":false},{"id":401482,"name":"Bryan F. Meyers","orcid":"0000-0003-2720-0312","position":6,"is_corresponding":false},{"id":376148,"name":"Ruben G. Nava","orcid":"0000-0001-5685-9445","position":7,"is_corresponding":false},{"id":403144,"name":"G. Alexander Patterson","orcid":null,"position":8,"is_corresponding":false},{"id":401483,"name":"Benjamin D. Kozower","orcid":"0000-0002-9059-5807","position":9,"is_corresponding":false},{"id":376149,"name":"Varun Puri","orcid":"0000-0001-7761-8421","position":10,"is_corresponding":false},{"id":253863,"name":"Whitney S. Brandt","orcid":"0000-0003-3839-7667","position":0,"is_corresponding":true}],"reference_count":20,"raw_metadata":null,"created_at":"2026-07-19T02:05:44.736405Z","pmid":"38883676","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}