Tumor stage, squamous histology and male sex predict positive resection margins in non-small cell lung cancer patients undergoing anatomical resection-a retrospective study from a high-volume thoracic surgery unit

BACKGROUND: The aim of the study is to identify perioperative predictors of positive resection margins in patients with non-small cell lung cancer (NSCLC) undergoing anatomical resections to improve perioperative risk stratification and ultimately, patient care. METHODS: All patients with primary NSCLC admitted at the Bundeswehrkrankenhaus (Armed Forces Hospital) Ulm for anatomical resections between 01.01.2019 and 31.12.2024 were retrospectively included into the study. Based on resection margins, patients were categorized in two groups: Group 1 (with negative resection margins, R(0)) and Group 2 (with tumor involvement at the level of resection margins/ positive resection margins at bronchial level, or adjacent structures, R(+)). A comparative analysis of patients' demographics, topographical, pathological tumor characteristics and surgical approach was performed by Mann-Whitney U test, Chi-squared test, and Fisher test. A logistic regression model was performed to assess the independent predictive value of the selected variables. RESULTS: Of 232 NSCLC patients [median age 69.00 (63.00, 75.00) years, 22% aged >75 years, and 2.2% with an Eastern Cooperative Oncology Group (ECOG) >2] who underwent anatomical resections, 107 (46.1%) female patients were included. While R(0) resections were observed in 214 (92.2%) patients, 18 (7.8%) patients had positive resection margins on histopathological evaluation. R(+) was more frequently reported in male patients (83.3% vs. 16.7%, P=0.009), large tumors (>50 mm/> pT(2), P<0.001), as well as in resection specimens with lymph node metastasis (pN(1-2), P<0.001), lymphangiosis (L(1), P=0.006), vascular invasion (V(1), P=0.008) and squamous histology (P<0.001). No significant differences were observed between groups in terms of lobar distribution, tumor mutational status, regression grade upon neoadjuvant therapy, as well as surgical approach (open/minimally invasive). Multivariable analysis revealed male sex (P=0.042), squamous histology (P=0.02), and pT >2 (P<0.001) as independent predictors for R(+). These predictors increased the risk of resection margin positivity by 4.1-, 3.7-, and 8.5-fold, respectively. CONCLUSIONS: T stage (pT >2), squamous histology and male sex predict positive resection margins in lung cancer patients undergoing anatomical resections. Consideration of these parameters could help in patients' stratification and care and thus, should be further evaluated in larger patients' cohorts.

• Stoleriu, M. G.
• Steinestel, K.
• Grimmer, M.
• Lower-Kiem, L. M.
• Witzenhausen, M.
• Solter, J.
• Brill, S.
• Arndt, A.