Lung Cancer Prognosis and Surgical Management

Lung cancer remains the leading cause of cancer mortality worldwide, with prognosis largely determined by stage at diagnosis, histological subtype and molecular profile. Early-stage disease confined to the lung may be managed surgically, with lobectomy standard for most tumours, while sublobar resections (segmentectomy or wedge resection) are increasingly considered for small or ground-glass nodules. Minimally invasive approaches, including video-assisted and robotic-assisted thoracic surgery, have reduced perioperative morbidity and improved recovery. Prognostic factors include tumour size, lymph node involvement, subsolid appearance on imaging, presence of spreading through air spaces and specific histological patterns such as micropapillary or solid components. Advances in preoperative risk stratification—from radiomic and deep-learning analysis of CT images to genomic and immune profiling—are refining surgical planning, guiding extent of resection and tailoring adjuvant therapies. A multidisciplinary approach that integrates imaging, pathology and molecular diagnostics is essential to optimise long-term outcomes and personalise follow-up strategies.

Research from Nature Portfolio

Multi-region exome sequencing of preneoplastic and early adenocarcinoma lesions has delineated a stepwise accumulation of single-nucleotide and chromosomal alterations from atypical adenomatous hyperplasia through minimally invasive and invasive adenocarcinoma, reinforcing the concept of a genomic evolutionary trajectory that may inform the timing of surgery. Genomic and immune profiling of adenocarcinoma in situ and minimally invasive adenocarcinoma has uncovered distinct mutational burdens and patterns of immune infiltration, linking specific copy number changes to local immune escape and supporting site-specific resection with minimal margins. Analysis of multiple synchronous lung cancers within individual patients has shown that anatomically separate nodules frequently represent independent primaries rather than intrapulmonary metastases, underscoring the importance of molecular clonality assessment for deciding between multiple limited resections versus more extensive anatomical procedures.

Lung Cancer Prognosis and Surgical Management publication trend

The graph below shows the total number of articles in lung cancer prognosis and surgical management across all publications each year (not limited to Nature Index journals).

Technical terms

Spreading Through Air Spaces (STAS): Tumour cells or clusters beyond the invasive margin within alveolar air spaces, associated with higher recurrence and influencing surgical margin decisions.

Atypical Adenomatous Hyperplasia (AAH): A small, localized proliferation of atypical alveolar epithelium considered a preneoplastic lesion in the adenocarcinoma pathway.

Minimally Invasive Adenocarcinoma (MIA): An adenocarcinoma ≤3 cm in diameter with ≤5 mm invasive component, linked to near-100 % disease-free survival if completely resected.

Micropapillary component: A histological subtype characterised by small papillary clusters without fibrovascular cores, indicating a propensity for lymphatic spread and poor prognosis.

References

1. Multi-region exome sequencing reveals genomic evolution from preneoplasia to lung adenocarcinoma. Nature Communications (2019).
2. Genomic and immune profiling of pre-invasive lung adenocarcinoma. Nature Communications (2019).
3. Genomic heterogeneity of multiple synchronous lung cancer. Nature Communications (2016).
4. An ensemble deep learning model for risk stratification of invasive lung adenocarcinoma using thin-slice CT. npj Digital Medicine (2023).
5. Improving the prediction of Spreading Through Air Spaces (STAS) in primary lung cancer with a dynamic dual-delta hybrid machine learning model: a multicenter cohort study. Biomarker Research (2023).
6. Minor Components of Micropapillary and Solid Subtypes in Lung Adenocarcinoma are Predictors of Lymph Node Metastasis and Poor Prognosis. Annals of Surgical Oncology (2016).