Visiting an old foe: distant recurrence following R0 lobectomy for pathological N0 lung adenocarcinoma

Lung cancer remains the leading cause of cancer-related death worldwide, with estimated 5-year survival rates for patients with pathological N0 (pN0) non-small cell lung cancer (NSCLC) as low as 56% (1,2). Although these staggering low survival rates could be attributed to a multitude of patient-related and tumor-related factors, recent evidence suggests that these outcomes are most likely related to tumor recurrence and metastasis (1,3-5). In this regard, identification of clinically relevant predictors for tumor recurrence is an integral step towards improving patient prognosis, with a goal of defining a relevant patient cohort that would benefit from possible additional therapies (either induction or adjuvant therapy).