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

Area of Science:

• Thoracic Oncology
• Surgical Oncology
• Translational Research

Background:

• Traditional staging for resectable non-small cell lung cancer (NSCLC) relies on anatomical resectability and pathological stage.
• These factors alone do not fully explain outcome variations after lung cancer surgery.
• Evidence suggests a need for novel prognostic determinants beyond conventional staging.

Purpose of the Study:

• To evaluate the need for a new heuristic framework in resectable NSCLC.
• To examine host-related, clinical, and data-driven factors influencing prognosis and treatment selection.
• To explore factors beyond conventional staging systems in NSCLC management.

Main Methods:

• Systematic review integrating clinical studies, national registries, and translational analyses.
• Examination of prognostic determinants and their impact on treatment selection.
• Analysis of data-driven approaches for subgroup identification.

Main Results:

• Advances in surgery, perioperative care, and systemic therapies have identified new prognostic factors.
• These include physiological reserve, nutritional status, inflammatory markers, comorbidities, and socioeconomic factors.
• Data-driven methods reveal clinically relevant subgroups missed by current staging.

Conclusions:

• A comprehensive heuristic framework is proposed for resectable NSCLC.
• This framework should integrate tumor biology, patient characteristics, and treatment context.
• Such an approach may better represent the complexity of modern thoracic oncology.