Association of symptoms at diagnosis with prognosis in patients with surgically treated stage I non-small cell lung cancer: a retrospective cohort analysis of a prospectively maintained registry

Background: Although most patients with stage I non-small cell lung cancer (NSCLC) are detected at an early and potentially curable stage, postoperative recurrence and mortality still occur after curative resection. Whether presenting symptoms at diagnosis provide additional prognostic information for risk stratification in surgically treated stage I NSCLC remains unclear. This study evaluated the association between symptoms at diagnosis and long-term outcomes in patients with pathologically confirmed stage I NSCLC.

Methods: This retrospective cohort study used single-institution data from West China Hospital, Sichuan University, within the Western China Lung Cancer Database, a prospectively maintained institutional registry. Patients with pathologically confirmed stage IA–IB NSCLC who underwent curative-intent surgical resection between 2011 and 2021 were included. Patients receiving non-surgical primary treatment, undergoing non-curative resection, or lacking detailed survival or treatment information were excluded. Presenting symptoms were extracted from electronic medical records at diagnosis. Baseline demographic, clinical, surgical, and pathological covariates were collected. Follow-up was conducted through outpatient visits, hospital record review, and telephone interviews. Cox regression models were used to evaluate associations with overall survival (OS) and disease-free survival (DFS).

Results: A total of 9,205 patients were included, of whom 2,657 (28.9%) were symptomatic at diagnosis. The most common symptoms were cough, chest pain, and blood-tinged sputum. Symptomatic patients were more likely to be older, male, smokers, and to have chronic obstructive pulmonary disease (COPD) or squamous cell carcinoma histology. Symptom presence was independently associated with poorer OS [adjusted hazard ratio (HR) =1.22, 95% confidence interval (CI): 1.01–1.47; P=0.03] and DFS (adjusted HR =1.27, 95% CI: 1.09–1.47; P=0.002). Among individual symptoms, blood-tinged sputum remained independently associated with worse OS (adjusted HR =1.71, 95% CI: 1.31–2.24; P<0.001) and DFS (adjusted HR =1.71, 95% CI: 1.36–2.14; P<0.001) after adjustment for demographic, clinical, surgical, and pathological covariates.

Conclusions: Presenting symptoms at diagnosis, particularly blood-tinged sputum, was associated with poorer long-term outcomes in patients with surgically treated stage I NSCLC. Symptom status may provide a simple clinical cue for postoperative risk stratification and may help identify patients who require closer surveillance after curative resection.