Association of one-year postoperative patient-reported outcomes with recurrence and survival in stage I non-small-cell lung cancer

BACKGROUND Recurrence risk and overall survival (OS) after curative-intent resection for stage I nonsmall-cell lung cancer remain incompletely explained by tumor-related variables.Patient-reported outcomes may capture dimensions of postoperative health not represented by conventional clinicopathologic factors, but their prognostic role during survivorship remains insufficiently defined.AIM To determine whether patient-reported outcomes assessed 1 year after surgery are associated with subsequent recurrence and OS.METHODS We analyzed 349 consecutive patients undergoing resection for pathological stage I nonsmall-cell lung cancer (NSCLC) between 2006 and 2018.The 1-year landmark cohort comprised 232 patients alive and recurrence-free with available health-related quality of life data.Global health status (QL2), fatigue (FA), and dyspnea (DY) from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 were evaluated.Recurrence was the primary endpoint, with death treated as a competing event.Multivariable recurrence analyses used cause-specific Firth Cox and Fine-Gray models; OS was assessed using multivariable Firth Cox regression. RESULTSDuring follow-up, 35 patients (15.1%) developed recurrence and 15 (6.5%) died without prior relapse.Age ≥ 65 years [hazard ratio (HR) = 6.51, 95%CI: 2.37-17.90],higher QL2 (HR = 2.50, 95%CI: 1.15-5.40),and higher FA (HR = 3.48, 95%CI: 1.66-7.27)were independently associated with recurrence, whereas DY was inversely associated (HR = 5 / 33 0.33, 95%CI: 0.16-0.71).Fine-Gray models yielded consistent estimates.For OS, age ≥ 65 years (HR = 4.90, 95%CI: 1.19-20.05)and DY > 0 (HR = 0.26, 95%CI: 0.09-0.81)were independently associated with mortality, whereas FA ≥ 22.2 showed a clinically relevant but borderline association (HR = 2.94, 95%CI: 0.96-9.02).Model discrimination was good for recurrence (C-index 0.79) and OS (C-index 0.73). CONCLUSIONPostoperative patient-reported outcomes assessed at 1 year were associated with heterogeneous recurrence and survival trajectories, suggesting complementary prognostic information during survivorship after stage I NSCLC resection.