Will We Need a Novel Heuristic in Resectable Lung Cancer?: A Narrative Review

Introduction: The management of resectable non-small cell lung cancer has long relied on a relatively limited set of determinants, primarily anatomical resectability and pathological stage. Although these parameters remain central to therapeutic planning, accumulating clinical and translational evidence indicates that they do not fully explain variability in outcomes observed after lung cancer surgery. The primary aim of this review is to evaluate whether current evidence supports the need for a novel heuristic framework in resectable NSCLC. Secondary aims are to examine how host-related, clinical, and data-driven factors contribute to prognosis and treatment selection beyond conventional staging systems. Methods: This review integrates evidence from clinical studies, national registries, and translational analyses to examine how these dimensions contribute to prognosis and treatment selection. Results: Over the past two decades, advances in surgical techniques, perioperative management, systemic therapies, and large-scale clinical databases have revealed additional determinants of prognosis beyond tumor burden, including physiological reserve, nutritional condition, systemic inflammatory state, comorbidities, and socioeconomic environment. Developments in multimodal strategies and minimally invasive surgery have reshaped the therapeutic landscape. Data-driven approaches have identified clinically meaningful subgroups not captured by conventional staging systems. Conclusions: A heuristic framework integrating tumor biology, patient characteristics, and treatment context may better reflect the complexity of contemporary thoracic oncology practice.