Long-Term Oncological Outcomes and Recurrence Patterns after Segmentectomy for Early-Stage Non-Small Cell Lung Cancer: A Dual-Centre Retrospective Study

Objectives To evaluate long-term oncologic outcomes and recurrence patterns following anatomical segmentectomy in patients with early-stage non-small cell lung cancer (NSCLC), and to identify preoperative and pathological factors associated with recurrence and survival.Methods We conducted a retrospective cohort study including patients with clinical stage IA1-IA2 NSCLC who underwent anatomical segmentectomy between 2014 and 2022 at 2 high-volume academic centres. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Fine-Gray competing risks models were used to assess predictors of local, regional, and distant recurrence, while Cox regression identified predictors of mortality. ROC curve analysis was used to identify cut-off values for continuous variables.Results A total of 209 patients were enrolled. The median follow-up was 58.5 mo. Five-year RFS and OS rates were 78.1% and 86.9%, respectively. Recurrence occurred in 20.1% of patients (5.7% local, 8.6% regional, 5.2% distant). Larger pathological tumour size, lingular resection, and lymphovascular invasion were associated with increased recurrence risk. At subtype analysis, low diffusing capacity of the lung for carbon monoxide (DLCO) and poor differentiation predicted local recurrence; tumour size, lymphovascular and pleural invasion predicted regional recurrence; while distant recurrence was associated with tumour size, grade, and open approach. At multivariable Cox analysis, pathological tumour size and higher neutrophil-to-lymphocyte ratio independently predicted mortality.Conclusions Segmentectomy yields favourable long-term outcomes in selected early-stage NSCLC. Tumour size, grade, lymphovascular and pleural invasion, and lingular location are key predictors of recurrence, while neutrophil-to-lymphocyte ratio (NLR) may serve as a simple inflammatory biomarker of poorer prognosis. Incorporating functional and inflammatory biomarkers into preoperative assessment may help refine patient selection and postoperative surveillance strategies.The rising incidence of small, peripheral non-small-cell lung cancers (NSCLC), particularly ground-glass opacity (GGO) lesions, is largely attributable to widespread implementation of low-dose CT screening and technological advances in imaging diagnostics.