{"paper_id":"331661d6-c4fa-47af-a61d-b972d8c8c19f","body_text":"Patient-Reported Outcomes of Radiofrequency Ablation versus Video-Assisted Thoracoscopic Surgery for Stage IA NSCLC: A Longitudinal Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient-Reported Outcomes of Radiofrequency Ablation versus Video-Assisted Thoracoscopic Surgery for Stage IA NSCLC: A Longitudinal Cohort Study Ruifeng Xu, Guochao Zhang, Na Ren, Yitong Lu, Fanmao Meng, Mengbai Tian, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7727753/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Radiofrequency ablation (RFA), a less invasive modality, demonstrates promising oncologic outcomes for early stage lung cancers. However, existing RFA data on patient-reported outcomes (PROs) remain scarce, particularly regarding postoperative recovery trajectories. To address this, an analysis of PROs from a cohort study was conducted to evaluate postoperative symptom burden and functional recovery RFA and VATS. Methods A single-center, real-world study was conducted, including 244 stage IA NSCLC patients treated between December 2023 and October 2024. PRO data were collected via the MD Anderson Symptom Inventory–Lung Cancer module (MDASI-LC) at baseline, postoperative days 1–7, and 1-, 3-month follow-ups. The primary outcomes were postoperative symptom burden and functional impairment. Mixed-effects models analyzed differences in symptom severity over time, while Kaplan–Meier analysis assessed recovery duration. Results RFA patients reported significantly milder symptoms at postoperative day 7, including pain (5.66% vs 38.96%, p < 0.0001), fatigue (5.66% vs 32.47%, p < 0.0001), and shortness of breath (8.81% vs 41.56%, p < 0.0001). Functional impairment in daily activities, work, and mobility was also lower in the RFA group at both day 7 and day 30 (all p < 0.0001). Mixed-effects modeling confirmed a protective effect of RFA on symptom burden and recovery, especially on pain (Estimate = -2.29583, p < 0.0001), fatigue (Estimate = -1.59997, p < 0.0001), general activity (Estimate = -1.77213, p < 0.0001), and work (Estimate = -1.56664, p < 0.0001). RFA patients had significantly shorter recovery times for key symptoms compared to VATS (all p < 0.0001). Conclusions RFA results in milder symptoms, faster recovery, and improved postoperative quality of life. These findings support RFA as a less invasive, patient-friendly alternative for early-stage NSCLC. Figures Figure 1 Figure 2 Figure 3 Introduction While surgical resection remains the recommended treatment for pulmonary tumors without lymph node metastasis [ 1 , 2 ] , thermal ablation (such as RFA, MWA), with its faster postoperative recovery and minimal invasiveness, holds potential for application in the treatment of multiple primary lung cancers [ 3 , 4 ] . As a minimally invasive local therapy, thermal ablation has been recommended by the NCCN NSCLC Guidelines (2025 V1) as the second-line treatment after stereotactic body radiation therapy (SBRT) for inoperable stage IA NSCLC patients [ 1 , 5 , 6 ] , demonstrating promising oncological efficacy while better preserving pulmonary function [ 7 ] . The cost-effectiveness of ablation techniques, attributable to their relatively lower consumable costs, positions them as a viable alternative to surgical intervention [ 8 , 9 ] . Traditional clinical practice has predominantly relied on objective indicators (postoperative CT findings, laboratory tests, drainage volume, and length of hospital stay) rather than patient-reported outcomes to assess postoperative recovery, leading to an incomplete evaluation of different surgical treatments [ 10 – 13 ] . In recent years, there has been increasing recognition of patient-reported outcomes (PROs) as essential clinical endpoints [ 14 – 23 ] , with the U.S. Food and Drug Administration approving their use in drug labeling-claim trials [ 24 ] . PROs provide critical insights into patients' authentic perceptions of symptom alleviation and functional recovery across different treatment modalities [ 19 , 25 , 26 ] . Previous studies by Wei et al. demonstrated through electronic PRO (ePRO) systems that VATS resulted in reduced postoperative symptom burden and minimized daily functional impairment compared to thoracotomy in locally advanced lung cancer [ 27 , 28 ] . However, few previous studies have used PROs to evaluate the application of RFA. This study aimed to delineate the postoperative recovery trajectory of patients undergoing RFA by observing their PROs within a cohort study, using data from conventional uniportal VATS as a reference. The findings are intended to provide a unique perspective on the postoperative symptom management for patients receiving RFA. Patients and Methods Study Design and Patients The 244 subjects were selected from a single-center real-world study which included NSCLC patients who presented to our center and underwent either uniportal video-assisted thoracoscopic surgery (VATS) or radiofrequency ablation (RFA) between December 2023 and October 2024. The real-world study was approved by the Ethics Committee of National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (IRB No. 23/050-3789). All participants provided written, informed consent. Figure 1 illustrates the patient selection process. The inclusion criteria for extracted cases were as follows: (1) age ≥ 18 years; (2) Clinical stage T1aN0M0 NSCLC; (3) Pathologically confirmed non-small cell lung cancer (NSCLC) or malignancy suspected on PET-CT/CECT (For RFA cases); (4) Active request for radiofrequency ablation therapy and deemed feasible by physician evaluation(For RFA cases); (5) Eastern Cooperative Oncology Group (ECOG) performance status score: 0–2; (6) Ability to provide written informed consent (ICF), with understanding and willingness to comply with study requirements and assessment schedules. The exclusion Criteria were as follows: (1) Previous treatment for the target lesion(s); (2) Clinical or radiological suspicion of lymph node metastasis; (3) Tumor stage greater than stage IA or those whose postoperative pathology confirmed non-malignant lung cancer; (4) Severely compromised cardiopulmonary function or high risk of pneumothorax due to severe emphysema; (5) Surgeries were canceled due to acute conditions, such as poor blood pressure control or menstruation onset.(6) Other conditions that can not conduct surgical interventions. Researchers participated in the real-world study had been trained with the standard operating procedure to ensure the accuracy of data collection. Data were collected and recorded on the ePRO data platform of National Cancer Center. PRO data, Demographic characteristics, preoperative characteristics, surgical information, postoperative pathological diagnosis (postoperative pathological staging was based on the eighth edition of the TNM classification for lung cancer), postoperative complications, and other clinical information were collected. Baseline variables with statistically significant differences, such as demographic characteristics and preoperative characteristics, were adjusted in the subsequent Mixed Effect Model (MEM) analysis. Surgical Approaches Image guided radiofrequency ablation (RFA) Patients were positioned on the CT examination bed before hybrid surgery. CT-guided surface marking technique was performed with metal grid paper to confirm the position of GGNs and puncture sites. Patients were locally anesthetized with ropivacaine and lidocaine and were ventilated using a mask airway. The puncture path was confirmed multiple times using chest CT. Experienced surgeons adjusted ablation parameters based on tumor size, location, morphology, adjacent structures, puncture path, and vessel diameter near the nodule. Subsequently, the RFA was conducted using the STARmedTM Radiofrequency Ablation System (STARmed, Korea) with VIVA RF Electrode (STARmed, Korea) cooled by water circulation. Additionally, RFA was performed with a host working frequency of 480 kHz, median power of 60 W, for 3–5 minutes or longer in our study. Finally, Chest CT was repeated to evaluate the sufficiency of ablation after RFA. If the post-ablation target zone (PTZ) was not at least 5 mm larger than the gross tumor region (GTR) [ 29 ] , supplemental ablation was conducted. Uniportal VATS In this study, VATS refer to single-port VATS, which usually involved a 3–4-cm incision in the fourth or fifth intercostal space between the anterior axillary line and the middle axillary line [ 30 , 31 ] . Under general anesthesia, the patient was ventilated using a double-lumen endotracheal tube and underwent disinfection according to the standard procedures for VATS in thoracic surgery. Outcome Measures Patient-reported outcome The MD Anderson Symptom Inventory–Lung Cancer module (MDASI-LC) is a disease-specific MDASI module comprising two parts. Part I includes 13 core symptoms and 3 lung cancer-specific symptoms (coughing, constipation, and sore throat); Part II includes 6 interfered items. MDASI-LC is a valid, reliable, and sensitive symptom assessment that can be used to assess symptom status in lung cancer patients and in epidemiological and prevalence studies of symptom severity [ 32 – 35 ] . The severity of symptoms were rated by patients on a 0–10 scale, as 0 was “absence of symptom”, 10 was “the worst symptoms one thinks”. Similarly, degree to which daily life is affected by symptoms were also rated on a 0–10 scale. Items scoring ≥ 4 were considered as moderate-to-severe symptoms or functional impairment. The MDASI-LC scale were completed through electronic questionnaires or phone interviews if patients can not read or use mobile phone. ePRO assessments were scheduled preoperatively (as baseline), postoperatively daily (up to 7 days), day 10, 14, 17, 21, 30, 42, 56, 60, 70, 90 after Surgical treatment [ 36 ] . Complications Postoperative complications were recorded for up to 4 weeks after discharge or until the start of postoperative cancer treatment using the Clavien–Dindo classification [ 37 ] . Statistical Analysis The patients were from 2 cohort (RFA and VATS cohort) according to the surgical treatment confirmed through the shared-decision making process. Continuous variables following a normal distribution are expressed as the mean ± standard deviation. Categorical variables are presented as numbers, percentages, or proportions. Baseline and clinical characteristics were compared between the VATS and RFA groups. For continuous variables, the t-test was applied to normally distributed data, while the Mann–Whitney U test was used for non-normally distributed data. Chi-square tests with Yates' correction and Fisher’s exact test were used for categorical variables. Longitudinal ePRO data were analyzed at baseline (POD 0), POD 1–7, 10, 14, 17, 21, 24, 30, 42, 56, 60, 70, 90 follow-ups. We calculated the completion rate of the questionnaire at each assessment point to ensure the validity of the ePRO results. The prevalence of moderate-to-severe symptoms (defined as scoring ≥ 4 points on the assessment scale at a time point) was quantified every time point (POD 0–7, 10, 14, 17, 21, 24, 30, 42, 56, 60, 70, 90) and reported as proportions of patients with 95% confidence intervals [ 38 , 39 ] . Mixed-effect models were used to assess whether scores differed significantly over time (POD 0–7, 10, 14, 17, 21, 24, 30, 42, 56, 60, 70, 90) between the different surgical treatment (RFA vs VATS). In these models, the independent variable was the score of each item as a continuous variable, and the dependent variables were time, treatment groups, interaction between time and treatment groups, hospital duration (in days), and baseline variables (which differed between groups in the univariate analysis). Additionally, The relative risks (RR) for moderate-to-severe symptoms and functional outcome on postoperative day 7 and day 30 were calculated using a mixed-effects model. Variables with statistical differences between the two groups were included in the mixed-effect model for adjustment. Postoperative recovery was defined as symptoms returning to none/mild level (0–3 on a 0–10-point scale). Between-group comparisons of recovery trajectory (Since the proportion of patients with moderate-to-severe symptoms in two groups were different, only patients with moderate-to-severe symptoms or function impairment were analysed.) based on surgical approach were conducted using Kaplan–Meier analysis with log-rank test. Two-sided p-value <0.05 was considered to be statistically significant. Analyses were performed using SAS 9.4 and Graphpad PRISM 10. Result Patient Characteristics Ultimately, a total of 244 patients were included in the analysis (Fig. 1 ). The mean age was comparable between groups (RFA: 57.69 ± 12.48 years vs. VATS: 57.15 ± 10.54 years; p = 0.4350). The proportion of patients aged ≤ 60 and > 60 years was also similar across both cohorts (p = 0.6079). 164 and 80 patients underwent RFA and VATS, respectively. A significant sex distribution difference was observed (p = 0.0005), with a higher proportion of male patients in the RFA group (62.20%), whereas the VATS cohort had a higher proportion of female patients (62.50%). There were no significant differences observed in Employment status, Smoking status, Comorbidity, Lobular location, Lesion morphology from preoperative chest CT (all p>0.05). Given that nearly half of the patients were unwilling to disclose their annual household income, the observed significant difference may not be meaningful. Due to the fact that RFA is the preferred modality for smaller nodules with a minimal solid portion, whereas VATS is typically reserved for larger (> 10 mm) mGGNs characterized by a greater solid component, A baseline discrepancy in Maximum diameter of lesion was observed in this two groups, the mean maximum lesion diameter was significantly larger in the VATS group (17.06 ± 8.994 mm) compared to the RFA cohort (11.15 ± 4.05 mm, p < 0.0001). Similarly, among patients with solid components (nRFA = 44, nVATS = 28), the mean maximum diameter of the solid portion was markedly greater in the VATS group (14.36 ± 10.96 mm) than in RFA (6.243 ± 4.179 mm, p < 0.0001). To account for this initial imbalance, the aforementioned baseline discrepancy was statistically controlled for in all subsequent analyses. The consolidation-to-tumor ratio (CTR) showed no significant difference between the groups (p = 0.1834). The histopathological distribution of lesions among patients in the VATS group (n = 80) is summarized in Table 1 . Consequently, none of the lesions treated with RFA had pathological results. Table 1 Patient Characteristics Characteristics RFA n = 164 VATS n = 80 p value Age, years, mean(SD) 57.69(12.48) 57.15(10.54) 0.4350 a Age, years, n(%) 0.6079 b ≤ 60 85(51.83%) 45(56.25%) > 60 79(48.17%) 35(43.75%) Sex, n(%) 0.0005 b Female 62(37.80%) 50(62.50%) Male 102(62.20%) 30(37.50%) Educational level, n(%) 0.9554 b ≤high school 78(47.56%) 37(46.25%) >high school 86(52.44%) 43(53.75%) Employment status, n(%) 0.9838 b Full or part-time 70(42.68%) 35(43.75%) Not currently working 94(57.32%) 45(56.25%) Annual household income, n(%) < 0.0001 b < 100,000 CNY 56(34.15%) 25(31.25%) ≥ 100,000 CNY 11(6.71%) 29(36.25%) Reluctance to disclose 97(59.15%) 36(45.00%) Smoking status, n(%) 0.2642 b Current or former 34(20.73%) 15(19.75%) Never 130(79.27%) 65(81.25%) Comorbidity (CCI), n(%) 0.5224 b 0 128(78.05%) 66(82.50%) ≥ 1 36(21.95%) 14(17.50%) Lesion Characteristics Lobular location 0.5881 c Right upper lobe, n(%) 48(29.27%) 20(25.00%) Right middle lobe, n(%) 10(6.10%) 7(8.75%) Right lower lobe, n(%) 37(22.56%) 13(16.25%) Left upper lobe, n(%) 42(25.61%) 23(28.75%) Left lower lobe, n(%) 27(16.46%) 17(21.25%) Lesion morphology from preoperative chest CT 0.3152 c Pure ground-glass opacity, n(%) 75(45.73%) 28(35.00%) Mixed ground-glass opacity, n(%) 31(18.90%) 20(25.00%) Solid, n(%) 10(6.10%) 8(10.00%) Multiple lesions, n(%) 48(29.27%) 24(30.00%) Maximum diameter, mm, mean (SD)*** 11.15(4.05) 17.06(8.994) < 0.0001 d Maximum diameter of solid component, mm, mean (SD)* 6.243(4.179) 14.36(10.96) < 0.0001 d Consolidation-to-tumour ratio, ratio, mean(SD)* 0.5105(0.3120) 0.6111(0.3060) 0.1834 d N stage from chest CT** N0 164 80 N1 or N2 0 0 Postoperative length of stay, days, median 5(2–11) 5(1–11) < 0.0001 a Histopathological Characteristics, n(%) AIS 16(20.00%) N/A MIA 7(8.75%) N/A Adenocarcinoma 54(67.50%) N/A non-Adenocarcinoma 3(3.75%) N/A *n(RFA) = 44, n(VATS) = 28 patients' lesions had solid components **Positive lymph nodes on CT chest defined as: mediastinal, hilar lymph nodes > 1cm in short diameter ***In case of multiple lesions, the largest lesion is measured a Mann–Whitney U test b Chi-square tests with Yates' correction, c Fisher exact probability test d t-test Complications Postoperative pneumothorax occurred in 4.88% of RFA patients and 1.25% of VATS patients (p = 0.2938). Pleural effusion was observed in 9.76% of RFA cases and 6.25% of VATS cases (p = 0.5006). Fever > 38°C, pneumonia, atelectasis, hemoptysis, and subcutaneous emphysema were reported only in the RFA group, with low incidence. Due to small event counts, statistical comparisons were not performed ( Supplemental Table 5 ). No significant differences were found between RFA and VATS in postoperative complications. All of the aforementioned complications were classified as Clavien-Dindo grade I and required no clinical intervention. The longitudinal follow-up of PRO data All the 244 patients provided MDASI-LC at the baseline(0 day). The completion rates of the MDASI-LC questionnaire were 100% at baseline, 98.77% to 96.72% during the 1–7 postoperative days, and from 95.49% to 86.07% in the follow-up ( Supplemental Table 1 ). Patient-reported outcomes The proportion of moderate-to-severe items The 10 most severe symptoms reported in both groups during the postoperative days (POD) 1–7 were disturbed sleep (21.09%), pain (19.21%), fatigue (18.30%), shortness of breath (17.87%), constipation (16.72%), dry mouth (13.19%), psychological distress (13.13%), coughing (12.34%), drowsy (10.76%), and remembering(forgetfulness) (10.15%) based on 1645 symptom assessments conducted throughout the postoperative period ( Supplemental Table 2 ). There was no significant difference between groups at baseline (day 0). At the POD 7, the proportion of patients with moderate-to-severe symptoms (RFA vs VATS) pain, RR = 0.11(0.05_to_0.28) ,5.66% vs 38.96%, p < 0.0001; fatigue, RR = 0.16(0.07_to_0.4), 5.66% vs 32.47%, p < 0.0001; disturbed sleep, RR = 0.22(0.1_to_0.5), 8.18% vs 32.47%, p = 0.0003; distressed, RR = 0.13(0.03_to_0.47), 2.52% vs 19.48%, p = 0.0020; shortness of breath, RR = 0.13(0.06_to_0.29), 8.81% vs 41.56%, p < 0.0001; lack of appetite, RR = 0.13(0.03_to_0.48), 1.89% vs 18.18%, p = 0.0023; drowsy, RR = 0.12(0.03_to_0.45), 1.89% vs 18.18%, p = 0.0017; dry mouth, RR = 0.25(0.09_to_0.66), 4.40% vs 19.48%, p = 0.0056; sad, RR = 0.13(0.07_to_0.62), 3.77% vs 19.48%, p = 0.0050; coughing, RR = 0.12(0.04_to_0.31), 5.03% vs 32.47%, p < 0.0001; sore throat, RR = 0.12(0.02_to_0.64), 1.89% vs 10.39%, p = 0.0129 was lower in the RFA group than in the U-VATS group after adjustment for age, maximum of tumor diameters, and other baseline variables with statistical differences (Fig. 2 , Supplemental Table 3 ). Given that the clinical indications for these two treatment modalities are not perfectly aligned, the comparative data from the VATS cohort is intended solely to serve as a benchmark for the level of symptomatic changes observed in the patient-reported outcomes (PROs) of the RFA group However, some symptoms showed no difference between groups at postoperative day 7 (nausea, 1.22% vs 8.75%, p = 0.0525; remembering, 4.88% vs 16.25%, p = 0.0558; vomiting, 1.22% vs 3.75%, p = 0.4774; numbness, 3.66% vs 8.75%, p = 0.2440; constipation, 9.76% vs 22.5%, p = 0.1298). As for proportion of patients with moderate-to-severe functional impairment, no between-group differences were observed at baseline (day 0),. Patients in the RFA group reported less moderate-to-severe functional impairment in all the functional items at postoperative day 7 and day 30 (Fig. 3 , Supplemental Table 3, 4 ), especially in the general activity (RR = 0.12(0.05_to_0.3), 6.10% vs 36.25%, p = 0.0008), mood (RR = 0.14(0.05_to_0.38), 4.27% vs 28.75%, p = 0.0204), relations (RR = 0.08(0.02_to_0.38), 1.83% vs 20.00%, p = 0.0043), Work(RR = 0.21(0.1_to_0.45), 9.15% vs 38.75%, p < 0.0001 ) at day 7. However, all the difference had shrunked at POD 90, no significance were observed in symptoms ( Supplemental Table 7 ). The proportion of all the symptoms and functional impairment from day 0 to day 90 were shown in Supplemental Fig. 1 (p-value showed the significance of difference between group comparison at day 30). In the RFA group, the proportion of patients experiencing moderate-to-severe symptoms and functional impairment remained relatively low. Notably, several moderate-to-severe symptoms—such as shortness of breath, lack of appetite, sadness, coughing, and sore throat—fluctuated in the postoperative period, rather than following the typical pattern of continuous decline after Postoperative Day 1 (POD1). Based on whether the proportion of moderate-to-severe symptoms rebounded postoperatively, symptoms were classified into two distinct patterns: a 'Sustained Resolution' group and a 'Short-Term Fluctuation' group. In contrast to RFA, the primary symptom trajectory for VATS was an 'oscillatory decline,' characterized by an initial decrease followed by subsequent fluctuations. ( Supplemental Fig. 1 ) The mixed-effects model analysis of patient-reported outcomes revealed associations between treatment modality (RFA versus VATS), time, and the interaction term across all measured items. The RFA cohort demonstrated protective effects on most symptoms and functions as expected, especially on pain (Estimate = -2.29583, p < 0.0001), fatigue (Estimate = -1.59997, p < 0.0001), general activity (Estimate = -1.77213, p < 0.0001), and work (Estimate = -1.56664, p < 0.0001). .These treatment advantages became progressively more pronounced over time, ultimately surpassing the temporal effects observed in the study (Table 2 , Supplementary Table 6 ). Table 2 PRO 0-7day Mixed effect model outcomes Items RFA versus VATS Group Time Group*Time Symptom Estimate SE p value Estimate SE p value Estimate SE p value pain -2.29583 0.18937 < 0.0001 -0.00536 0.00179 0.00277 0.02387 0.00318 < 0.0001 fatigue -1.59997 0.21865 < 0.0001 -0.00261 0.00166 0.11609 0.01713 0.00296 < 0.0001 nausea -0.68910 0.13837 < 0.0001 -0.00113 0.00124 0.36295 0.00480 0.00221 0.02983 disturbed.sleep -1.38701 0.24480 < 0.0001 -0.00443 0.00199 0.02605 0.01170 0.00354 0.00096 distressed -1.23720 0.22086 < 0.0001 -0.00132 0.00157 0.40099 0.01040 0.00280 0.00022 shortness.of.breath -1.45477 0.20871 < 0.0001 -0.00119 0.00166 0.47218 0.01095 0.00295 0.00021 remembering -0.32755 0.21935 0.13697 -0.00076 0.00135 0.57312 -0.00173 0.00241 0.47218 lack.of.appetite -1.01971 0.18539 < 0.0001 -0.00046 0.00139 0.74271 0.00877 0.00248 0.00042 drowsy -1.00785 0.18945 < 0.0001 -0.00098 0.00148 0.50804 0.01063 0.00264 0.00006 dry.mouth -0.62106 0.25152 0.01439 -0.00278 0.00164 0.08987 0.00786 0.00292 0.00720 sad -0.79138 0.22058 0.00042 0.00091 0.00136 0.50071 0.00813 0.00241 0.00077 vomiting -0.39562 0.12342 0.00157 -0.00031 0.00102 0.75757 0.00302 0.00181 0.09530 numbness -0.73304 0.16168 < 0.0001 0.00055 0.00122 0.65065 0.00073 0.00217 0.73770 coughing -1.36741 0.18530 < 0.0001 -0.00174 0.00154 0.25996 0.00473 0.00275 0.08572 constipation -1.09563 0.23381 < 0.0001 -0.00659 0.00194 0.00071 0.01010 0.00346 0.00353 sore.throat -0.69894 0.15503 < 0.0001 -0.00092 0.00130 0.48091 0.00739 0.00231 0.00140 General.activity -1.77213 0.20804 < 0.0001 -0.00341 0.00168 0.04282 0.01139 0.00300 0.00015 Mood -1.18898 0.22019 < 0.0001 -0.00097 0.00144 0.50167 0.00735 0.00257 0.00422 Work -1.56664 0.26820 < 0.0001 -0.00616 0.00200 0.00216 0.00561 0.00357 0.11641 Relations -0.70170 0.19654 0.00045 0.00135 0.00132 0.30487 0.00158 0.00235 0.50056 Walking -1.48828 0.22267 < 0.0001 -0.00241 0.00168 0.15010 0.01041 0.00299 0.00050 Enjoyment -1.15578 0.23562 < 0.0001 -0.00043 0.00157 0.78199 0.00757 0.00280 0.00689 Statistically significant values are given in bold (p <0.05) Adjusted variables: Sex, postoperative hospital duration, Annual household income, Maximum diameter. Group*time refers to the interaction between groups and the total time The score in MDASI-LC were illstrated in Supplementary Fig. 3 , showing a trend similar to that in Supplementary Fig. 2 . Discussion Previous studies have primarily focused on comparisons between uniportal and multiportal video-assisted thoracoscopic surgery (VATS), VATS versus thoracotomy, and surgery versus radiotherapy [ 27 , 40 , 41 ] . In this study, we delineate the recovery trajectories and patterns for moderate-to-severe symptoms and functional impairment in patients following RFA, using uniportal VATS as a reference. A direct comparison of PROs between RFA and VATS is subject to significant bias due to their differing clinical indications. Nevertheless, the VATS cohort was included as a comparator in this study to contextualize the relative symptom burden in RFA patients and to offer a familiar benchmark for the thoracic surgery community. Through the analysis of postoperative symptoms for these two surgical techniques, we identified distinct recovery patterns. In the RFA cohort, which was characterized by a lower overall proportion of moderate-to-severe symptoms, we classified two primary trajectories: a 'Sustained Resolution' pattern and a 'Short-Term Fluctuation' pattern. In contrast, the VATS cohort exclusively exhibited a single trajectory: the 'oscillatory decline'. The observed differences can be attributed to the minimally invasive nature of RFA [ 42 , 43 ] , which avoids thoracic incisions, leading to reduced surgical trauma and a lower systemic inflammatory response [ 44 , 45 ] . This may also be attributed to the fact that a drainage tube is typically placed after VATS, whereas it is generally not required following radiofrequency ablation (RFA). Additionally, VATS is performed under general anesthesia, whereas RFA is conducted under local anesthesia. Consequently, the RFA group exhibited a significantly shorter recovery time for key functional items such as general activity, walking, and work (Figure 3 , Supplemental Fig. 2 ). This suggests that RFA may offer a more favorable postoperative recovery trajectory, particularly for working individuals who seek a quicker return to occupational and daily responsibilities. Our study offers several distinct contributions to the literature on post-RFA recovery. First, to our knowledge, this is the first investigation to apply the MDASI-LC instrument for a comprehensive evaluation of symptom burden and functional outcomes specifically in patients undergoing thoracic RFA. This approach identified a unique symptom profile—primarily involving constipation, shortness of breath, sleep disturbance, pain, fatigue, and memory impairment—that differs notably from those reported after conventional thoracic surgery [ 41 ] .Second, our prospective, multi-time-point data collection within the first 90 postoperative days, coupled with a high data acquisition rate, allowed for a high-resolution characterization of the recovery trajectory. This robust methodology enabled us to clearly demonstrate the rapid pace of symptom resolution following RFA. This study has several limitations that should be acknowledged. First and foremost, inherent differences exist between the RFA and VATS cohorts. The two procedures have distinct clinical indications, and the associated levels of surgical trauma and methods of anesthesia are not directly comparable. Therefore, while the VATS data provides a useful benchmark for contextualizing the recovery trajectory after RFA, its direct comparative value is limited. Second, a potential for selection bias exists, as preoperative histopathological confirmation was not routinely performed for RFA cases. This is largely because the majority of RFA-treated lesions were small ground-glass nodules (mGGNs/pGGNs), for which preoperative biopsy is often technically challenging. The use of percutaneous needles carries a risk of hemorrhage, which can obscure imaging and complicate subsequent ablation targeting. Third, the 90-day follow-up period may not be sufficient to capture the full spectrum of long-term symptomatic recovery. However, we contend that the primary advantage of RFA—its rapid early recovery—may reduce the clinical relevance of symptom comparisons in the longer term. Finally, ongoing randomized controlled trials with extended follow-up will be crucial for further validating the long-term benefits of RFA. Conclusion Our findings suggest that RFA is a less functionally impairing and more patient-friendly treatment alternative to VATS for early-stage NSCLC. The superior symptom recovery and functional outcomes associated with RFA support its broader clinical adoption, particularly for patients prioritizing a swift return to work and daily activities in this rapidly running era. Abbreviations Abbreviation Full Term NSCLC Non-Small Cell Lung Cancer RFA Radiofrequency Ablation VATS Video-Assisted Thoracoscopic Surgery PRO Patient-Reported Outcomes MDASI-LC MD Anderson Symptom Inventory–Lung Cancer module CT Computed Tomography PET-CT Positron Emission Tomography-Computed Tomography CECT Contrast-Enhanced Computed Tomography ECOG Eastern Cooperative Oncology Group GGN Ground-Glass Nodule PTZ Post-Ablation Target Zone GTR Gross Tumor Region MWA Microwave Ablation SBRT Stereotactic Body Radiation Therapy CTR Consolidation-to-Tumor Ratio SAS Statistical Analysis Software FDA Food and Drug Administration ePRO Electronic Patient-Reported Outcomes POD Postoperative Day Declarations Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was conducted at the Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. It was approved by the Research Ethics Committee of the Cancer Hospital, Chinese Academy of Medical Sciences (23/050-3789). All participants provided written, informed consent. Consent for publication: Not applicable Availability of data and materials: The datasets generated and analyzed during this study are available from the corresponding authors upon reasonable request. Due to patient privacy protections under the ethical approval granted by the Research Ethics Committee of the Cancer Hospital, Chinese Academy of Medical Sciences (Approval No. 23/050-3789), access to de-identified data requires formal approval from the institutional review board. Researchers interested in utilizing the data may submit a detailed proposal to the Ethics Committee via the corresponding authors. Competing Interest s: The authors declare no potential conflicts of interest. Funding : This work was supported by the National Natural Science Foundation of China (82203154), the Capital’s Funds for Health Improvement and Research (2024-2-4027), National Key R&D Program of China (2022YFC2407404), National High Level Hospital Clinical Research Funding and Cooperation Fund of CHCAMS Beijing & Langfang & SZCH (CFA202502013, CFA202503003), National High Level Hospital Clinical Research Funding (N0. LC2024D01, 80102022501), CAMS Innovation Fund for Medical Sciences(CIFMS) (2025-I2M-C&T-B-041, 2025-I2M-C&T-B-058), Beijing Hope Run Special Fund of Cancer Foundation of China (LC2021L01); Author contributions: Ruifeng Xu contributed to study concepts, study design, data analysis and interpretation, statistical analysis, manuscript preparation, and manuscript editing. Guochao Zhang and Na Ren contributed to study concepts, study design, data analysis and interpretation. Yitong Lu and Fanmao Meng contributed to data acquisition, quality control of data and algorithms. Mengbai Tian, Mufei Sun, Hongrui Wang and Xin liang contributed to data acquisition, quality control of data and algorithms, and manuscript preparation. Yu Tian, Xin Sun and Yun Che contributed to study design, data acquisition, supervision, and manuscript editing. Liang Zhao contributed to study concepts, study design, funding acquisition, supervision, and manuscript review. 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Supplementary Files SupplementaryFigureLegendsofPRO.docx SupplementaryFigure1090symptomsfunction.pdf SupplementaryFigure2combinedrecoverycurves1to90.pdf SupplementaryFigure3MEMscorepod190.pdf SupplementaryTableofPROdata20250218.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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04:43:51\",\"extension\":\"docx\",\"order_by\":10,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":48236,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryTableofPROdata20250218.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/6cd029612d0c5c2963eca41d.docx\"},{\"id\":94625284,\"identity\":\"9721a9d6-0b7a-46fb-bdfe-36aa0e4bc448\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 04:43:51\",\"extension\":\"xml\",\"order_by\":11,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":215979,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"dc2748a1349846278da7d368d12687ab1enriched.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/fd637be59a7dfedda95db540.xml\"},{\"id\":94640107,\"identity\":\"584cc525-6d00-4822-888b-8397f3771578\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 07:48:18\",\"extension\":\"pdf\",\"order_by\":12,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":32839,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Figure1Flowchart.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/4f244ef421ee6dc174117a11.pdf\"},{\"id\":94625283,\"identity\":\"0d81a301-8b74-4143-ae97-30b9c2827ae7\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 04:43:51\",\"extension\":\"pdf\",\"order_by\":13,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":56031,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Figure27dsignificant11symptoms.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/44467de540f2f7b4e2bd47f2.pdf\"},{\"id\":94625276,\"identity\":\"bd355ad2-e92b-4621-a931-005164bca645\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 04:43:51\",\"extension\":\"pdf\",\"order_by\":14,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":41983,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Figure36functions.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/989318ddaa0107956b968816.pdf\"},{\"id\":94640012,\"identity\":\"8ee20d47-5cfb-4e2b-a0a7-3818d31d1a41\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 07:47:50\",\"extension\":\"xml\",\"order_by\":15,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":214003,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"dc2748a1349846278da7d368d12687ab1structuring.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/d5c845ffdfe0deca77f872d4.xml\"},{\"id\":94640060,\"identity\":\"9829c608-e3e3-463a-aa76-6a92f5f4efb4\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 07:48:08\",\"extension\":\"html\",\"order_by\":16,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":223696,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/4f923f96953db8b7266fdb3e.html\"},{\"id\":94625265,\"identity\":\"2b38de1f-7a1f-457d-9e3d-57499d1a2c1d\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 04:43:50\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":210632,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFlow chart of patient selection.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1Flowchart.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/03cab7bc3f27583eb8407930.png\"},{\"id\":94640055,\"identity\":\"52b92000-daab-4157-906f-c70934a4509c\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 07:48:04\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":475188,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePostoperative 11 Siginificant Symptom Burden Over the First 7 Days in RFA vs. VATS Groups\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;compares the proportion of patients reporting moderate-to-severe symptoms (score ≥4/10) over the first seven postoperative days following radiofrequency ablation (RFA) or video-assisted thoracoscopic surgery (VATS) for stage IA NSCLC. Symptoms include pain, fatigue, shortness of breath, disturbed sleep, distress, and others. Mixed-effects logistic regression adjusted for baseline factors, and Chi-square tests were used for analysis at POD 7, p-values shows the significance of difference at POD 7 . RFA patients had significantly lower symptom burdens across multiple items (e.g., pain, p\\u0026lt;0.0001; shortness of breath, p\\u0026lt;0.0001), suggesting a more favorable recovery profile compared to VATS.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure27dsignificant11symptoms.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/863431fe748ba8cced690bda.png\"},{\"id\":94625269,\"identity\":\"3906c5e2-e39b-4467-9b8b-5eb12079e016\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 04:43:50\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":403935,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePostoperative Functional Impairment Over the First 7 Days in RFA vs. VATS Groups\\u003c/p\\u003e\\n\\u003cp\\u003ecompares proportions of patients with moderate-to-severe functional impairment (score ≥4/10) in six items—work, walking, general activity, enjoyment, mood, and relationships—over the first seven postoperative days in RFA and VATS patients with stage IA NSCLC. Mixed-effects logistic regression adjusted for baseline factors, and chi-square tests assessed between-group differences at POD 30, p-values shows the significance of difference at POD 30(e.g., work, p\\u0026lt;0.0001; walking, p\\u0026lt;0.0001). RFA patients had significantly lower impairment rates across all functions, indicating faster recovery and better postoperative functional outcomes compared to VATS.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure36functions.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/7687775e63bc9abc06e54da5.png\"},{\"id\":96708716,\"identity\":\"2fa80e38-54f7-44f0-9b73-6213b0ab7f6e\",\"added_by\":\"auto\",\"created_at\":\"2025-11-25 10:05:14\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2361896,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/7d02cfca-333f-4cdb-99d7-f11480f1be27.pdf\"},{\"id\":94625264,\"identity\":\"b491fa27-9b4c-4186-8047-f3ad8be867b3\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 04:43:50\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":12560,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryFigureLegendsofPRO.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/b2252f0073a3413a8dd70034.docx\"},{\"id\":94625272,\"identity\":\"e2ad34ed-d2ad-4606-970a-5e507521bce9\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 04:43:51\",\"extension\":\"pdf\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":126576,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryFigure1090symptomsfunction.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/78b4dc7f9df2c0add83939ba.pdf\"},{\"id\":94625271,\"identity\":\"7faf4e58-7226-4da2-81e7-f4c06d79ab3a\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 04:43:50\",\"extension\":\"pdf\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":14955,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryFigure2combinedrecoverycurves1to90.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/81253739a6db44246de1594c.pdf\"},{\"id\":94625278,\"identity\":\"088e99e1-5c25-48ad-b1dc-efb31bcc9986\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 04:43:51\",\"extension\":\"pdf\",\"order_by\":4,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":891867,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryFigure3MEMscorepod190.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/c5379bed3f5dc973e751170c.pdf\"},{\"id\":94639943,\"identity\":\"4df3f5d2-037e-4887-aa72-9da046a7c181\",\"added_by\":\"auto\",\"created_at\":\"2025-10-29 07:46:39\",\"extension\":\"docx\",\"order_by\":5,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":48236,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryTableofPROdata20250218.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7727753/v1/e3a6086011877bedea1810eb.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Patient-Reported Outcomes of Radiofrequency Ablation versus Video-Assisted Thoracoscopic Surgery for Stage IA NSCLC: A Longitudinal Cohort Study\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eWhile surgical resection remains the recommended treatment for pulmonary tumors without lymph node metastasis\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e, thermal ablation (such as RFA, MWA), with its faster postoperative recovery and minimal invasiveness, holds potential for application in the treatment of multiple primary lung cancers\\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eAs a minimally invasive local therapy, thermal ablation has been recommended by the NCCN NSCLC Guidelines (2025 V1) as the second-line treatment after stereotactic body radiation therapy (SBRT) for inoperable stage IA NSCLC patients\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e, demonstrating promising oncological efficacy while better preserving pulmonary function\\u003csup\\u003e[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e. The cost-effectiveness of ablation techniques, attributable to their relatively lower consumable costs, positions them as a viable alternative to surgical intervention\\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eTraditional clinical practice has predominantly relied on objective indicators (postoperative CT findings, laboratory tests, drainage volume, and length of hospital stay) rather than patient-reported outcomes to assess postoperative recovery, leading to an incomplete evaluation of different surgical treatments\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR11 CR12\\\" citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e. In recent years, there has been increasing recognition of patient-reported outcomes (PROs) as essential clinical endpoints\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22\\\" citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]\\u003c/sup\\u003e, with the U.S. Food and Drug Administration approving their use in drug labeling-claim trials\\u003csup\\u003e[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]\\u003c/sup\\u003e. PROs provide critical insights into patients' authentic perceptions of symptom alleviation and functional recovery across different treatment modalities\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e. Previous studies by Wei et al. demonstrated through electronic PRO (ePRO) systems that VATS resulted in reduced postoperative symptom burden and minimized daily functional impairment compared to thoracotomy in locally advanced lung cancer\\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]\\u003c/sup\\u003e. However, few previous studies have used PROs to evaluate the application of RFA. This study aimed to delineate the postoperative recovery trajectory of patients undergoing RFA by observing their PROs within a cohort study, using data from conventional uniportal VATS as a reference. The findings are intended to provide a unique perspective on the postoperative symptom management for patients receiving RFA.\\u003c/p\\u003e\"},{\"header\":\"Patients and Methods\",\"content\":\"\\u003cp\\u003eStudy Design and Patients\\u003c/p\\u003e\\u003cp\\u003eThe 244 subjects were selected from a single-center real-world study which included NSCLC patients who presented to our center and underwent either uniportal video-assisted thoracoscopic surgery (VATS) or radiofrequency ablation (RFA) between December 2023 and October 2024. The real-world study was approved by the Ethics Committee of National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (IRB No. 23/050-3789). All participants provided written, informed consent. Figure\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e illustrates the patient selection process.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe inclusion criteria for extracted cases were as follows: (1) age ≥ 18 years; (2) Clinical stage T1aN0M0 NSCLC; (3) Pathologically confirmed non-small cell lung cancer (NSCLC) or malignancy suspected on PET-CT/CECT (For RFA cases); (4) Active request for radiofrequency ablation therapy and deemed feasible by physician evaluation(For RFA cases); (5) Eastern Cooperative Oncology Group (ECOG) performance status score: 0–2; (6) Ability to provide written informed consent (ICF), with understanding and willingness to comply with study requirements and assessment schedules.\\u003c/p\\u003e\\u003cp\\u003eThe exclusion Criteria were as follows: (1) Previous treatment for the target lesion(s); (2) Clinical or radiological suspicion of lymph node metastasis; (3) Tumor stage greater than stage IA or those whose postoperative pathology confirmed non-malignant lung cancer; (4) Severely compromised cardiopulmonary function or high risk of pneumothorax due to severe emphysema; (5) Surgeries were canceled due to acute conditions, such as poor blood pressure control or menstruation onset.(6) Other conditions that can not conduct surgical interventions.\\u003c/p\\u003e\\u003cp\\u003eResearchers participated in the real-world study had been trained with the standard operating procedure to ensure the accuracy of data collection.\\u003c/p\\u003e\\u003cp\\u003eData were collected and recorded on the ePRO data platform of National Cancer Center. PRO data, Demographic characteristics, preoperative characteristics, surgical information, postoperative pathological diagnosis (postoperative pathological staging was based on the eighth edition of the TNM classification for lung cancer), postoperative complications, and other clinical information were collected.\\u003c/p\\u003e\\u003cp\\u003eBaseline variables with statistically significant differences, such as demographic characteristics and preoperative characteristics, were adjusted in the subsequent Mixed Effect Model (MEM) analysis.\\u003c/p\\u003e\\u003cp\\u003eSurgical Approaches\\u003c/p\\u003e\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eImage guided radiofrequency ablation (RFA)\\u003c/h2\\u003e\\u003cp\\u003ePatients were positioned on the CT examination bed before hybrid surgery. CT-guided surface marking technique was performed with metal grid paper to confirm the position of GGNs and puncture sites. Patients were locally anesthetized with ropivacaine and lidocaine and were ventilated using a mask airway. The puncture path was confirmed multiple times using chest CT. Experienced surgeons adjusted ablation parameters based on tumor size, location, morphology, adjacent structures, puncture path, and vessel diameter near the nodule. Subsequently, the RFA was conducted using the STARmedTM Radiofrequency Ablation System (STARmed, Korea) with VIVA RF Electrode (STARmed, Korea) cooled by water circulation. Additionally, RFA was performed with a host working frequency of 480 kHz, median power of 60 W, for 3–5 minutes or longer in our study. Finally, Chest CT was repeated to evaluate the sufficiency of ablation after RFA. If the post-ablation target zone (PTZ) was not at least 5 mm larger than the gross tumor region (GTR)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]\\u003c/sup\\u003e, supplemental ablation was conducted.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eUniportal VATS\\u003c/h3\\u003e\\n\\u003cp\\u003eIn this study, VATS refer to single-port VATS, which usually involved a 3–4-cm incision in the fourth or fifth intercostal space between the anterior axillary line and the middle axillary line\\u003csup\\u003e[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e. Under general anesthesia, the patient was ventilated using a double-lumen endotracheal tube and underwent disinfection according to the standard procedures for VATS in thoracic surgery.\\u003c/p\\u003e\\u003cp\\u003eOutcome Measures\\u003c/p\\u003e\\n\\u003ch3\\u003ePatient-reported outcome\\u003c/h3\\u003e\\n\\u003cp\\u003eThe MD Anderson Symptom Inventory–Lung Cancer module (MDASI-LC) is a disease-specific MDASI module comprising two parts. Part I includes 13 core symptoms and 3 lung cancer-specific symptoms (coughing, constipation, and sore throat); Part II includes 6 interfered items. MDASI-LC is a valid, reliable, and sensitive symptom assessment that can be used to assess symptom status in lung cancer patients and in epidemiological and prevalence studies of symptom severity\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR33 CR34\\\" citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e–\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e. The severity of symptoms were rated by patients on a 0–10 scale, as 0 was “absence of symptom”, 10 was “the worst symptoms one thinks”. Similarly, degree to which daily life is affected by symptoms were also rated on a 0–10 scale. Items scoring ≥ 4 were considered as moderate-to-severe symptoms or functional impairment.\\u003c/p\\u003e\\u003cp\\u003eThe MDASI-LC scale were completed through electronic questionnaires or phone interviews if patients can not read or use mobile phone. ePRO assessments were scheduled preoperatively (as baseline), postoperatively daily (up to 7 days), day 10, 14, 17, 21, 30, 42, 56, 60, 70, 90 after Surgical treatment\\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003ch3\\u003eComplications\\u003c/h3\\u003e\\n\\u003cp\\u003ePostoperative complications were recorded for up to 4 weeks after discharge or until the start of postoperative cancer treatment using the Clavien–Dindo classification\\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e\\u003cp\\u003eThe patients were from 2 cohort (RFA and VATS cohort) according to the surgical treatment confirmed through the shared-decision making process.\\u003c/p\\u003e\\u003cp\\u003eContinuous variables following a normal distribution are expressed as the mean ± standard deviation. Categorical variables are presented as numbers, percentages, or proportions. Baseline and clinical characteristics were compared between the VATS and RFA groups. For continuous variables, the t-test was applied to normally distributed data, while the Mann–Whitney U test was used for non-normally distributed data. Chi-square tests with Yates' correction and Fisher’s exact test were used for categorical variables.\\u003c/p\\u003e\\u003cp\\u003eLongitudinal ePRO data were analyzed at baseline (POD 0), POD 1–7, 10, 14, 17, 21, 24, 30, 42, 56, 60, 70, 90 follow-ups. We calculated the completion rate of the questionnaire at each assessment point to ensure the validity of the ePRO results. The prevalence of moderate-to-severe symptoms (defined as scoring ≥ 4 points on the assessment scale at a time point) was quantified every time point (POD 0–7, 10, 14, 17, 21, 24, 30, 42, 56, 60, 70, 90) and reported as proportions of patients with 95% confidence intervals\\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eMixed-effect models were used to assess whether \\u003cb\\u003escores\\u003c/b\\u003e differed significantly over time (POD 0–7, 10, 14, 17, 21, 24, 30, 42, 56, 60, 70, 90) between the different surgical treatment (RFA vs VATS). In these models, the independent variable was the score of each item as a continuous variable, and the dependent variables were time, treatment groups, interaction between time and treatment groups, hospital duration (in days), and baseline variables (which differed between groups in the univariate analysis). Additionally, The relative risks (RR) for moderate-to-severe symptoms and functional outcome on postoperative day 7 and day 30 were calculated using a mixed-effects model. Variables with statistical differences between the two groups were included in the mixed-effect model for adjustment.\\u003c/p\\u003e\\u003cp\\u003ePostoperative recovery was defined as symptoms returning to none/mild level (0–3 on a 0–10-point scale). Between-group comparisons of recovery trajectory (Since the proportion of patients with moderate-to-severe symptoms in two groups were different, only patients with moderate-to-severe symptoms or function impairment were analysed.) based on surgical approach were conducted using Kaplan–Meier analysis with log-rank test.\\u003c/p\\u003e\\u003cp\\u003eTwo-sided p-value \\u0026lt;0.05 was considered to be statistically significant. Analyses were performed using SAS 9.4 and Graphpad PRISM 10.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Result\",\"content\":\"\\u003cp\\u003ePatient Characteristics\\u003c/p\\u003e\\u003cp\\u003eUltimately, a total of 244 patients were included in the analysis (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). The mean age was comparable between groups (RFA: 57.69 ± 12.48 years vs. VATS: 57.15 ± 10.54 years; p = 0.4350). The proportion of patients aged ≤ 60 and \\u0026gt; 60 years was also similar across both cohorts (p = 0.6079). 164 and 80 patients underwent RFA and VATS, respectively. A significant sex distribution difference was observed (p = 0.0005), with a higher proportion of male patients in the RFA group (62.20%), whereas the VATS cohort had a higher proportion of female patients (62.50%). There were no significant differences observed in Employment status, Smoking status, Comorbidity, Lobular location, Lesion morphology from preoperative chest CT (all p\\u0026gt;0.05). Given that nearly half of the patients were unwilling to disclose their annual household income, the observed significant difference may not be meaningful. Due to the fact that RFA is the preferred modality for smaller nodules with a minimal solid portion, whereas VATS is typically reserved for larger (\\u0026gt; 10 mm) mGGNs characterized by a greater solid component, A baseline discrepancy in Maximum diameter of lesion was observed in this two groups, the mean maximum lesion diameter was significantly larger in the VATS group (17.06 ± 8.994 mm) compared to the RFA cohort (11.15 ± 4.05 mm, p \\u0026lt; 0.0001). Similarly, among patients with solid components (nRFA = 44, nVATS = 28), the mean maximum diameter of the solid portion was markedly greater in the VATS group (14.36 ± 10.96 mm) than in RFA (6.243 ± 4.179 mm, p \\u0026lt; 0.0001). To account for this initial imbalance, the aforementioned baseline discrepancy was statistically controlled for in all subsequent analyses. The consolidation-to-tumor ratio (CTR) showed no significant difference between the groups (p = 0.1834). The histopathological distribution of lesions among patients in the VATS group (n = 80) is summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Consequently, none of the lesions treated with RFA had pathological results.\\u003c/p\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePatient Characteristics\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003c/colgroup\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCharacteristics\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eRFA n = 164\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eVATS n = 80\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ep value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eAge, years, mean(SD)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e57.69(12.48)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e57.15(10.54)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.4350\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eAge, years, n(%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.6079\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e≤ 60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e85(51.83%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e45(56.25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026gt; 60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e79(48.17%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e35(43.75%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSex, n(%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.0005\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003eb\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e62(37.80%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e50(62.50%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e102(62.20%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e30(37.50%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eEducational level, n(%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.9554\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e≤high school\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e78(47.56%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e37(46.25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026gt;high school\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e86(52.44%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e43(53.75%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eEmployment status, n(%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.9838\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFull or part-time\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e70(42.68%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e35(43.75%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNot currently working\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e94(57.32%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e45(56.25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eAnnual household income, n(%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003eb\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026lt; 100,000 CNY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e56(34.15%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25(31.25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e≥ 100,000 CNY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e11(6.71%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e29(36.25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eReluctance to disclose\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e97(59.15%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e36(45.00%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSmoking status, n(%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.2642\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCurrent or former\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e34(20.73%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e15(19.75%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNever\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e130(79.27%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e65(81.25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eComorbidity (CCI), n(%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.5224\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e128(78.05%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e66(82.50%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e≥ 1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e36(21.95%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14(17.50%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eLesion Characteristics\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eLobular location\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.5881\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRight upper lobe, n(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e48(29.27%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20(25.00%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRight middle lobe, n(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e10(6.10%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7(8.75%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRight lower lobe, n(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e37(22.56%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13(16.25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLeft upper lobe, n(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e42(25.61%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e23(28.75%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLeft lower lobe, n(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e27(16.46%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e17(21.25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eLesion morphology from preoperative chest CT\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.3152\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePure ground-glass opacity, n(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e75(45.73%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e28(35.00%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMixed ground-glass opacity, n(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e31(18.90%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20(25.00%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSolid, n(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e10(6.10%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8(10.00%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMultiple lesions, n(%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e48(29.27%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24(30.00%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMaximum diameter, mm, mean (SD)***\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e11.15(4.05)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e17.06(8.994)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003ed\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMaximum diameter of solid component, mm, mean (SD)*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e6.243(4.179)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14.36(10.96)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003ed\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eConsolidation-to-tumour ratio, ratio, mean(SD)*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.5105(0.3120)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.6111(0.3060)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.1834\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eN stage from chest CT**\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e164\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN1 or N2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePostoperative length of stay, days, median\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5(2–11)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5(1–11)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003ea\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eHistopathological Characteristics, n(%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eAIS\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e16(20.00%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN/A\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMIA\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7(8.75%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN/A\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eAdenocarcinoma\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e54(67.50%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN/A\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003enon-Adenocarcinoma\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3(3.75%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN/A\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e*n(RFA) = 44, n(VATS) = 28 patients' lesions had solid components\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e**Positive lymph nodes on CT chest defined as: mediastinal, hilar lymph nodes \\u0026gt; 1cm in short diameter\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e***In case of multiple lesions, the largest lesion is measured\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003e Mann–Whitney U test\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003csup\\u003eb\\u003c/sup\\u003e Chi-square tests with Yates' correction,\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003csup\\u003ec\\u003c/sup\\u003e Fisher exact probability test\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003csup\\u003ed\\u003c/sup\\u003e t-test\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003cp\\u003eComplications\\u003c/p\\u003e\\u003cp\\u003ePostoperative pneumothorax occurred in 4.88% of RFA patients and 1.25% of VATS patients (p = 0.2938). Pleural effusion was observed in 9.76% of RFA cases and 6.25% of VATS cases (p = 0.5006). Fever \\u0026gt; 38°C, pneumonia, atelectasis, hemoptysis, and subcutaneous emphysema were reported only in the RFA group, with low incidence. Due to small event counts, statistical comparisons were not performed (\\u003cb\\u003eSupplemental Table\\u0026nbsp;5\\u003c/b\\u003e).\\u003c/p\\u003e\\u003cp\\u003eNo significant differences were found between RFA and VATS in postoperative complications. All of the aforementioned complications were classified as Clavien-Dindo grade I and required no clinical intervention.\\u003c/p\\u003e\\u003cp\\u003eThe longitudinal follow-up of PRO data\\u003c/p\\u003e\\u003cp\\u003eAll the 244 patients provided MDASI-LC at the baseline(0 day). The completion rates of the MDASI-LC questionnaire were 100% at baseline, 98.77% to 96.72% during the 1–7 postoperative days, and from 95.49% to 86.07% in the follow-up (\\u003cb\\u003eSupplemental Table\\u0026nbsp;1\\u003c/b\\u003e).\\u003c/p\\u003e\\u003cp\\u003ePatient-reported outcomes\\u003c/p\\u003e\\u003cp\\u003eThe proportion of moderate-to-severe items\\u003c/p\\u003e\\u003cp\\u003eThe 10 most severe symptoms reported in both groups during the postoperative days (POD) 1–7 were disturbed sleep (21.09%), pain (19.21%), fatigue (18.30%), shortness of breath (17.87%), constipation (16.72%), dry mouth (13.19%), psychological distress (13.13%), coughing (12.34%), drowsy (10.76%), and remembering(forgetfulness) (10.15%) based on 1645 symptom assessments conducted throughout the postoperative period (\\u003cb\\u003eSupplemental Table\\u0026nbsp;2\\u003c/b\\u003e). There was no significant difference between groups at baseline (day 0). At the POD 7, the proportion of patients with moderate-to-severe symptoms (RFA vs VATS) pain, RR = 0.11(0.05_to_0.28) ,5.66% vs 38.96%, p \\u0026lt; 0.0001; fatigue, RR = 0.16(0.07_to_0.4), 5.66% vs 32.47%, p \\u0026lt; 0.0001; disturbed sleep, RR = 0.22(0.1_to_0.5), 8.18% vs 32.47%, p = 0.0003; distressed, RR = 0.13(0.03_to_0.47), 2.52% vs 19.48%, p = 0.0020; shortness of breath, RR = 0.13(0.06_to_0.29), 8.81% vs 41.56%, p \\u0026lt; 0.0001; lack of appetite, RR = 0.13(0.03_to_0.48), 1.89% vs 18.18%, p = 0.0023; drowsy, RR = 0.12(0.03_to_0.45), 1.89% vs 18.18%, p = 0.0017; dry mouth, RR = 0.25(0.09_to_0.66), 4.40% vs 19.48%, p = 0.0056; sad, RR = 0.13(0.07_to_0.62), 3.77% vs 19.48%, p = 0.0050; coughing, RR = 0.12(0.04_to_0.31), 5.03% vs 32.47%, p \\u0026lt; 0.0001; sore throat, RR = 0.12(0.02_to_0.64), 1.89% vs 10.39%, p = 0.0129 was lower in the RFA group than in the U-VATS group after adjustment for age, maximum of tumor diameters, and other baseline variables with statistical differences (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cb\\u003eSupplemental Table\\u0026nbsp;3\\u003c/b\\u003e). Given that the clinical indications for these two treatment modalities are not perfectly aligned, the comparative data from the VATS cohort is intended solely to serve as a benchmark for the level of symptomatic changes observed in the patient-reported outcomes (PROs) of the RFA group\\u003c/p\\u003e\\u003cp\\u003eHowever, some symptoms showed no difference between groups at postoperative day 7 (nausea, 1.22% vs 8.75%, p = 0.0525; remembering, 4.88% vs 16.25%, p = 0.0558; vomiting, 1.22% vs 3.75%, p = 0.4774; numbness, 3.66% vs 8.75%, p = 0.2440; constipation, 9.76% vs 22.5%, p = 0.1298).\\u003c/p\\u003e\\u003cp\\u003eAs for proportion of patients with moderate-to-severe functional impairment, no between-group differences were observed at baseline (day 0),. Patients in the RFA group reported less moderate-to-severe functional impairment in all the functional items at postoperative day 7 and day 30 (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cb\\u003eSupplemental Table\\u0026nbsp;3, 4\\u003c/b\\u003e), especially in the general activity (RR = 0.12(0.05_to_0.3), 6.10% vs 36.25%, p = 0.0008), mood (RR = 0.14(0.05_to_0.38), 4.27% vs 28.75%, p = 0.0204), relations (RR = 0.08(0.02_to_0.38), 1.83% vs 20.00%, p = 0.0043), Work(RR = 0.21(0.1_to_0.45), 9.15% vs 38.75%, p \\u0026lt; 0.0001 ) at day 7.\\u003c/p\\u003e\\u003cp\\u003eHowever, all the difference had shrunked at POD 90, no significance were observed in symptoms (\\u003cb\\u003eSupplemental Table\\u0026nbsp;7\\u003c/b\\u003e). The proportion of all the symptoms and functional impairment from day 0 to day 90 were shown in \\u003cb\\u003eSupplemental Fig.\\u0026nbsp;1\\u003c/b\\u003e (p-value showed the significance of difference between group comparison at day 30).\\u003c/p\\u003e\\u003cp\\u003eIn the RFA group, the proportion of patients experiencing moderate-to-severe symptoms and functional impairment remained relatively low. Notably, several moderate-to-severe symptoms—such as shortness of breath, lack of appetite, sadness, coughing, and sore throat—fluctuated in the postoperative period, rather than following the typical pattern of continuous decline after Postoperative Day 1 (POD1). Based on whether the proportion of moderate-to-severe symptoms rebounded postoperatively, symptoms were classified into two distinct patterns: a 'Sustained Resolution' group and a 'Short-Term Fluctuation' group. In contrast to RFA, the primary symptom trajectory for VATS was an 'oscillatory decline,' characterized by an initial decrease followed by subsequent fluctuations. (\\u003cb\\u003eSupplemental Fig.\\u0026nbsp;1\\u003c/b\\u003e)\\u003c/p\\u003e\\u003cp\\u003eThe mixed-effects model analysis of patient-reported outcomes revealed associations between treatment modality (RFA versus VATS), time, and the interaction term across all measured items. The RFA cohort demonstrated protective effects on most symptoms and functions as expected, especially on pain (Estimate = -2.29583, p \\u0026lt; 0.0001), fatigue (Estimate = -1.59997, p \\u0026lt; 0.0001), general activity (Estimate = -1.77213, p \\u0026lt; 0.0001), and work (Estimate = -1.56664, p \\u0026lt; 0.0001). .These treatment advantages became progressively more pronounced over time, ultimately surpassing the temporal effects observed in the study (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cb\\u003eSupplementary Table\\u0026nbsp;6\\u003c/b\\u003e).\\u003c/p\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePRO 0-7day Mixed effect model outcomes\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"10\\\"\\u003e\\u003c/colgroup\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eItems\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"9\\\" nameend=\\\"c10\\\" namest=\\\"c2\\\"\\u003e\\u003cp\\u003eRFA versus VATS\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGroup\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eTime\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eGroup*Time\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSymptom\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eEstimate\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSE\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ep value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eEstimate\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eSE\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003ep value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eEstimate\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003eSE\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003ep value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003epain\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-2.29583\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.18937\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.00536\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.00179\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.00277\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.02387\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00318\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003efatigue\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-1.59997\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.21865\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.00261\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.00166\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.11609\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.01713\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00296\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003enausea\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-0.68910\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.13837\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.00113\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.00124\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.36295\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.00480\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00221\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.02983\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003edisturbed.sleep\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-1.38701\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.24480\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.00443\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.00199\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.02605\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.01170\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00354\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.00096\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003edistressed\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-1.23720\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.22086\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.00132\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.00157\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.40099\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.01040\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00280\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" 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colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.00735\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00257\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.00422\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWork\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-1.56664\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.26820\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.00616\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.00200\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.00216\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.00561\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00357\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.11641\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRelations\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-0.70170\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.19654\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.00045\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.00135\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.00132\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.30487\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.00158\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00235\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.50056\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWalking\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-1.48828\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.22267\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.00241\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.00168\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.15010\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.01041\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00299\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.00050\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEnjoyment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-1.15578\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.23562\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt; 0.0001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.00043\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.00157\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.78199\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.00757\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.00280\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.00689\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003eStatistically significant values are given in bold (p \\u0026lt;0.05)\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003eAdjusted variables: Sex, postoperative hospital duration, Annual household income, Maximum diameter.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003eGroup*time refers to the interaction between groups and the total time\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003cp\\u003eThe score in MDASI-LC were illstrated in \\u003cb\\u003eSupplementary Fig.\\u0026nbsp;3\\u003c/b\\u003e, showing a trend similar to that in \\u003cb\\u003eSupplementary Fig.\\u0026nbsp;2\\u003c/b\\u003e.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003ePrevious studies have primarily focused on comparisons between uniportal and multiportal video-assisted thoracoscopic surgery (VATS), VATS versus thoracotomy, and surgery versus radiotherapy\\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e. In this study, we delineate the recovery trajectories and patterns for moderate-to-severe symptoms and functional impairment in patients following RFA, using uniportal VATS as a reference. A direct comparison of PROs between RFA and VATS is subject to significant bias due to their differing clinical indications. Nevertheless, the VATS cohort was included as a comparator in this study to contextualize the relative symptom burden in RFA patients and to offer a familiar benchmark for the thoracic surgery community.\\u003c/p\\u003e\\u003cp\\u003eThrough the analysis of postoperative symptoms for these two surgical techniques, we identified distinct recovery patterns. In the RFA cohort, which was characterized by a lower overall proportion of moderate-to-severe symptoms, we classified two primary trajectories: a 'Sustained Resolution' pattern and a 'Short-Term Fluctuation' pattern. In contrast, the VATS cohort exclusively exhibited a single trajectory: the 'oscillatory decline'. The observed differences can be attributed to the minimally invasive nature of RFA\\u003csup\\u003e[\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e, which avoids thoracic incisions, leading to reduced surgical trauma and a lower systemic inflammatory response\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e]\\u003c/sup\\u003e. This may also be attributed to the fact that a drainage tube is typically placed after VATS, whereas it is generally not required following radiofrequency ablation (RFA). Additionally, VATS is performed under general anesthesia, whereas RFA is conducted under local anesthesia.\\u003c/p\\u003e\\u003cp\\u003eConsequently, the RFA group exhibited a significantly shorter recovery time for key functional items such as general activity, walking, and work (Figure \\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cb\\u003eSupplemental Fig.\\u0026nbsp;2\\u003c/b\\u003e). This suggests that RFA may offer a more favorable postoperative recovery trajectory, particularly for working individuals who seek a quicker return to occupational and daily responsibilities.\\u003c/p\\u003e\\u003cp\\u003eOur study offers several distinct contributions to the literature on post-RFA recovery. First, to our knowledge, this is the first investigation to apply the MDASI-LC instrument for a comprehensive evaluation of symptom burden and functional outcomes specifically in patients undergoing thoracic RFA. This approach identified a unique symptom profile\\u0026mdash;primarily involving constipation, shortness of breath, sleep disturbance, pain, fatigue, and memory impairment\\u0026mdash;that differs notably from those reported after conventional thoracic surgery\\u003csup\\u003e[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e.Second, our prospective, multi-time-point data collection within the first 90 postoperative days, coupled with a high data acquisition rate, allowed for a high-resolution characterization of the recovery trajectory. This robust methodology enabled us to clearly demonstrate the rapid pace of symptom resolution following RFA.\\u003c/p\\u003e\\u003cp\\u003eThis study has several limitations that should be acknowledged. First and foremost, inherent differences exist between the RFA and VATS cohorts. The two procedures have distinct clinical indications, and the associated levels of surgical trauma and methods of anesthesia are not directly comparable. Therefore, while the VATS data provides a useful benchmark for contextualizing the recovery trajectory after RFA, its direct comparative value is limited. Second, a potential for selection bias exists, as preoperative histopathological confirmation was not routinely performed for RFA cases. This is largely because the majority of RFA-treated lesions were small ground-glass nodules (mGGNs/pGGNs), for which preoperative biopsy is often technically challenging. The use of percutaneous needles carries a risk of hemorrhage, which can obscure imaging and complicate subsequent ablation targeting. Third, the 90-day follow-up period may not be sufficient to capture the full spectrum of long-term symptomatic recovery. However, we contend that the primary advantage of RFA\\u0026mdash;its rapid early recovery\\u0026mdash;may reduce the clinical relevance of symptom comparisons in the longer term. Finally, ongoing randomized controlled trials with extended follow-up will be crucial for further validating the long-term benefits of RFA.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eOur findings suggest that RFA is a less functionally impairing and more patient-friendly treatment alternative to VATS for early-stage NSCLC. The superior symptom recovery and functional outcomes associated with RFA support its broader clinical adoption, particularly for patients prioritizing a swift return to work and daily activities in this rapidly running era.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"144\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAbbreviation\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFull Term\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eNSCLC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eNon-Small Cell Lung Cancer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eRFA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eRadiofrequency Ablation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eVATS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eVideo-Assisted Thoracoscopic Surgery\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003ePRO\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003ePatient-Reported Outcomes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eMDASI-LC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eMD Anderson Symptom Inventory\\u0026ndash;Lung Cancer module\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eCT\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eComputed Tomography\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003ePET-CT\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003ePositron Emission Tomography-Computed Tomography\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eCECT\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eContrast-Enhanced Computed Tomography\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eECOG\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eEastern Cooperative Oncology Group\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eGGN\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eGround-Glass Nodule\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003ePTZ\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003ePost-Ablation Target Zone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eGTR\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eGross Tumor Region\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eMWA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eMicrowave Ablation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eSBRT\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eStereotactic Body Radiation Therapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eCTR\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eConsolidation-to-Tumor Ratio\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eSAS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eStatistical Analysis Software\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eFDA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eFood and Drug Administration\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eePRO\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eElectronic Patient-Reported Outcomes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003ePOD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003ePostoperative Day\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate:\\u0026nbsp;\\u003c/strong\\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eThis study was conducted at the Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. It was approved by the Research Ethics Committee of the Cancer Hospital, Chinese Academy of Medical Sciences (23/050-3789). All participants provided written, informed consent.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u0026nbsp;\\u003c/strong\\u003eThe datasets generated and analyzed during this study are available from the corresponding authors upon reasonable request. Due to patient privacy protections under the ethical approval granted by the Research Ethics Committee of the Cancer Hospital, Chinese Academy of Medical Sciences (Approval No. 23/050-3789), access to de-identified data requires formal approval from the institutional review board. Researchers interested in utilizing the data may submit a detailed proposal to the Ethics Committee via the corresponding authors.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interest\\u003c/strong\\u003e\\u003cstrong\\u003es:\\u0026nbsp;\\u003c/strong\\u003eThe authors declare no potential conflicts of interest.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e: This work was supported by the National Natural Science Foundation of China (82203154), the Capital\\u0026rsquo;s Funds for Health Improvement and Research (2024-2-4027), National Key R\\u0026amp;D Program of China (2022YFC2407404), National High Level Hospital Clinical Research Funding and Cooperation Fund of CHCAMS Beijing \\u0026amp; Langfang \\u0026amp; SZCH (CFA202502013, CFA202503003), National High Level Hospital Clinical Research Funding (N0. LC2024D01, 80102022501), CAMS Innovation Fund for Medical Sciences(CIFMS) (2025-I2M-C\\u0026amp;T-B-041, 2025-I2M-C\\u0026amp;T-B-058), Beijing Hope Run Special Fund of Cancer Foundation of China (LC2021L01);\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions:\\u0026nbsp;\\u003c/strong\\u003eRuifeng Xu contributed to study concepts, study design, data analysis and interpretation, statistical analysis, manuscript preparation, and manuscript editing. Guochao Zhang and Na Ren contributed to study concepts, study design, data analysis and interpretation. Yitong Lu and Fanmao Meng contributed to data acquisition, quality control of data and algorithms. Mengbai Tian, Mufei Sun, Hongrui Wang and Xin liang contributed to data acquisition, quality control of data and algorithms, and manuscript preparation. Yu Tian, Xin Sun and Yun Che contributed to study design, data acquisition, supervision, and manuscript editing. Liang Zhao contributed to study concepts, study design, funding acquisition, supervision, and manuscript review.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAckownledgements:\\u0026nbsp;\\u003c/strong\\u003eNo specific individuals or organizations need to be acknowledged for this work.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eRiely GJ, Wood DE, Ettinger DS, Aisner DL, Akerley W, Bauman JR, Bharat A, Bruno DS, Chang JY, Chirieac LR, DeCamp M, Desai AP, Dilling TJ, Dowell J, Durm GA, Gettinger S, Grotz TE, Gubens MA, Juloori A, Lackner RP, Lanuti M, Lin J, Loo BW, Lovly CM, Maldonado F, Massarelli E, Morgensztern D, Mullikin TC, Ng T, Owen D, Owen DH, Patel SP, Patil T, Polanco PM, Riess J, Shapiro TA, Singh AP, Stevenson J, Tam A, Tanvetyanon T, Yanagawa J, Yang SC, Yau E, Gregory KM, Hang L. Non-Small Cell Lung Cancer, Version 4.2024, NCCN Clinical Practice Guidelines in Oncology. 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Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer. J Clin Oncol. 1998;16(11):3662-73.\\u003c/li\\u003e\\n\\u003cli\\u003eGu Z, Wu L, Li J, Zheng S, Huang M. A Visual Analysis of Patient-Reported Outcomes in Lung Cancer From 2013 to 2023. Cancer Control. 2024;31:10732748241266490.\\u003c/li\\u003e\\n\\u003cli\\u003eXiao C, Hurst N, Movsas B. The State of the Science in Patient-Reported Outcomes for Patients with Lung Cancer. Semin Respir Crit Care Med. 2020;41(3):377-85.\\u003c/li\\u003e\\n\\u003cli\\u003eYi H, Ou-Yang X, Hong Q, Liu L, Liu M, Wang Y, Zhang G, Ma F, Mu J, Mao Y. Patient-reported outcomes in lung cancer surgery: A narrative review. Asian J Surg. 2024.\\u003c/li\\u003e\\n\\u003cli\\u003eBasch E. The missing voice of patients in drug-safety reporting. 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J Pain Symptom Manage. 2016;52(6):822-31.\\u003c/li\\u003e\\n\\u003cli\\u003eSantosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction. JAMA Surg. 2018;153(10):891-9.\\u003c/li\\u003e\\n\\u003cli\\u003eKhullar OV, Rajaei MH, Force SD, Binongo JN, Lasanajak Y, Robertson S, Pickens A, Sancheti MS, Lipscomb J, Gillespie TW, Fernandez FG. Pilot Study to Integrate Patient Reported Outcomes After Lung Cancer Operations Into The Society of Thoracic Surgeons Database. Ann Thorac Surg. 2017;104(1):245-53.\\u003c/li\\u003e\\n\\u003cli\\u003eGuidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health Qual Life Outcomes. 2006;4:79.\\u003c/li\\u003e\\n\\u003cli\\u003eZhang K, Liu W, Zhao Y, Gao X, Dai W, Zhou X, Yu H, Shi Q, Li Q, Wei X. Comparison of early postoperative patient-reported outcomes after multiportal robotic-assisted thoracoscopic surgery and uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer. Eur J Surg Oncol. 2024;50(9):108481.\\u003c/li\\u003e\\n\\u003cli\\u003eYu H, Lei C, Wei X, Wang Y, Xu W, Tang L, Dai W, Liao J, Pu Y, Gong R, Su X, Yu Q, Zhang J, Zhang L, Huang Y, Zhuang X, Bai J, Wang Z, Li Q, Shi Q. Electronic symptom monitoring after lung cancer surgery: establishing a core set of patient-reported outcomes for surgical oncology care in a longitudinal cohort study. Int J Surg. 2024;110(10):6591-600.\\u003c/li\\u003e\\n\\u003cli\\u003eWei X, Yu H, Dai W, Mu Y, Wang Y, Liao J, Peng L, Han Y, Li Q, Shi Q. Patient-Reported Outcomes of Video-Assisted Thoracoscopic Surgery Versus Thoracotomy for Locally Advanced Lung Cancer: A Longitudinal Cohort Study. Ann Surg Oncol. 2021;28(13):8358-71.\\u003c/li\\u003e\\n\\u003cli\\u003eDai W, Xie S, Zhang R, Wei X, Wu C, Zhang Y, Feng W, Liao X, Mu Y, Zhou H, Cheng X, Jiang Y, He J, Li Q, Yang X, Shi Q. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients with lung cancer: a multicentre, prospective, observational cohort study protocol. BMJ Open. 2019;9(10):e030726.\\u003c/li\\u003e\\n\\u003cli\\u003eYe X, Fan W, Wang Z, Wang J, Wang H, Wang J, Wang C, Niu L, Fang Y, Gu S, Tian H, Liu B, Liu L, Zhong L, Zhuang Y, Chi J, Sun X, Yang N, Wei Z, Li X, Li X, Li Y, Li C, Li Y, Yang X, Yang W, Yang P, Yang Z, Xiao Y, Song X, Zhang K, Chen S, Chen W, Lin Z, Lin D, Meng Z, Zhao X, Hu K, Liu C, Liu C, Gu C, Xu D, Huang Y, Huang G, Peng Z, Dong L, Jiang L, Han Y, Zeng Q, Jin Y, Lei G, Zhai B, Li H, Pan J. Expert consensus on thermal ablation therapy of pulmonary subsolid nodules (2021 Edition). J Cancer Res Ther. 2021;17(5):1141-56.\\u003c/li\\u003e\\n\\u003cli\\u003eZhang J, Zhao H, Lv L, Yuan J, Sun Y. Uniportal thoracoscopic pulmonary lobectomy in the treatment of Lung Cancer. Pak J Med Sci. 2020;36(2):182-6.\\u003c/li\\u003e\\n\\u003cli\\u003eDai F, Meng S, Mei L, Guan C, Ma Z. Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis. J Thorac Dis. 2016;8(10):2872-8.\\u003c/li\\u003e\\n\\u003cli\\u003eMendoza TR, Wang XS, Lu C, Palos GR, Liao Z, Mobley GM, Kapoor S, Cleeland CS. Measuring the symptom burden of lung cancer: the validity and utility of the lung cancer module of the M. D. Anderson Symptom Inventory. Oncologist. 2011;16(2):217-27.\\u003c/li\\u003e\\n\\u003cli\\u003eWang XS, Wang Y, Guo H, Mendoza TR, Hao XS, Cleeland CS. Chinese version of the M. D. Anderson Symptom Inventory: validation and application of symptom measurement in cancer patients. Cancer. 2004;101(8):1890-901.\\u003c/li\\u003e\\n\\u003cli\\u003eXu W, Dai W, Xing W, Shi Q. ASO Author Reflections: Using Minimal Clinically Important Improvement for Patient-Reported Symptoms to Define Recovery. Ann Surg Oncol. 2022;29(9):5605-6.\\u003c/li\\u003e\\n\\u003cli\\u003eYu H, Yu Q, Nie Y, Xu W, Pu Y, Dai W, Wei X, Shi Q. Data Quality of Longitudinally Collected Patient-Reported Outcomes After Thoracic Surgery: Comparison of Paper- and Web-Based Assessments. J Med Internet Res. 2021;23(11):e28915.\\u003c/li\\u003e\\n\\u003cli\\u003eHarris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.\\u003c/li\\u003e\\n\\u003cli\\u003eDindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.\\u003c/li\\u003e\\n\\u003cli\\u003eDai W, Wang Y, Liao J, Wei X, Dai Z, Xu W, Liu Y, Wang XS, Pompili C, Yu H, Pu Y, Zhao Y, Cao B, Wang Q, Feng W, Zhang Y, Liu F, Deng Y, Zhou J, Li J, Xie S, Xiang R, Wang X, Tian B, Yang X, Hu B, Liu X, Xie T, Yang X, Zhuang X, Qiao G, Li Q, Shi Q. Electronic Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: Long-Term Results of a Multicenter, Randomized, Controlled Trial. J Clin Oncol. 2024;42(18):2126-31.\\u003c/li\\u003e\\n\\u003cli\\u003eDai W, Feng W, Zhang Y, Wang XS, Liu Y, Pompili C, Xu W, Xie S, Wang Y, Liao J, Wei X, Xiang R, Hu B, Tian B, Yang X, Wang X, Xiao P, Lai Q, Wang X, Cao B, Wang Q, Liu F, Liu X, Xie T, Yang X, Zhuang X, Wu Z, Che G, Li Q, Shi Q. Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial. J Clin Oncol. 2022;40(9):988-96.\\u003c/li\\u003e\\n\\u003cli\\u003eDai W, Dai Z, Wei X, Pompili C, Shi QL, Xie TP, He JT, Li Q. Early Patient-Reported Outcomes After Uniportal vs Multiportal Thoracoscopic Lobectomy. Ann Thorac Surg. 2022;114(4):1229-37.\\u003c/li\\u003e\\n\\u003cli\\u003eLouie AV, van Werkhoven E, Chen H, Smit EF, Paul MA, Widder J, Groen HJ, van den Borne BE, De Jaeger K, Slotman BJ, Senan S. Patient reported outcomes following stereotactic ablative radiotherapy or surgery for stage IA non-small-cell lung cancer: Results from the ROSEL multicenter randomized trial. Radiother Oncol. 2015;117(1):44-8.\\u003c/li\\u003e\\n\\u003cli\\u003ede Baere T, Tselikas L, Catena V, Buy X, Deschamps F, Palussi\\u0026egrave;re J. Percutaneous thermal ablation of primary lung cancer. Diagn Interv Imaging. 2016;97(10):1019-24.\\u003c/li\\u003e\\n\\u003cli\\u003eFuzhi Y, Dongfang T, Wentao F, Jing W, Yingting W, Nianping M, Wen G, Xiaoyong S. Rapid Recovery of Postoperative Pulmonary Function in Patients With Lung Cancer and Influencing Factors. Front Oncol. 2022;12:927108.\\u003c/li\\u003e\\n\\u003cli\\u003eLi G, Xue M, Chen W, Yi S. Efficacy and safety of radiofrequency ablation for lung cancers: A systematic review and meta-analysis. Eur J Radiol. 2018;100:92-8.\\u003c/li\\u003e\\n\\u003cli\\u003eLin M, Eiken P, Blackmon S. Image guided thermal ablation in lung cancer treatment. J Thorac Dis. 2020;12(11):7039-47.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7727753/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7727753/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003eRadiofrequency ablation (RFA), a less invasive modality, demonstrates promising oncologic outcomes for early stage lung cancers. However, existing RFA data on patient-reported outcomes (PROs) remain scarce, particularly regarding postoperative recovery trajectories. To address this, an analysis of PROs from a cohort study was conducted to evaluate postoperative symptom burden and functional recovery RFA and VATS.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eA single-center, real-world study was conducted, including 244 stage IA NSCLC patients treated between December 2023 and October 2024. PRO data were collected via the MD Anderson Symptom Inventory\\u0026ndash;Lung Cancer module (MDASI-LC) at baseline, postoperative days 1\\u0026ndash;7, and 1-, 3-month follow-ups. The primary outcomes were postoperative symptom burden and functional impairment. Mixed-effects models analyzed differences in symptom severity over time, while Kaplan\\u0026ndash;Meier analysis assessed recovery duration.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eRFA patients reported significantly milder symptoms at postoperative day 7, including pain (5.66% vs 38.96%, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001), fatigue (5.66% vs 32.47%, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001), and shortness of breath (8.81% vs 41.56%, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001). Functional impairment in daily activities, work, and mobility was also lower in the RFA group at both day 7 and day 30 (all p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001). Mixed-effects modeling confirmed a protective effect of RFA on symptom burden and recovery, especially on pain (Estimate = -2.29583, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001), fatigue (Estimate = -1.59997, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001), general activity (Estimate = -1.77213, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001), and work (Estimate = -1.56664, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001). RFA patients had significantly shorter recovery times for key symptoms compared to VATS (all p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001).\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\u003cp\\u003eRFA results in milder symptoms, faster recovery, and improved postoperative quality of life. These findings support RFA as a less invasive, patient-friendly alternative for early-stage NSCLC.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Patient-Reported Outcomes of Radiofrequency Ablation versus Video-Assisted Thoracoscopic Surgery for Stage IA NSCLC: A Longitudinal Cohort Study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-10-29 04:43:46\",\"doi\":\"10.21203/rs.3.rs-7727753/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"e526a480-254d-45fb-8f8b-031f13957dc2\",\"owner\":[],\"postedDate\":\"October 29th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-11-24T10:24:05+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-10-29 04:43:46\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7727753\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7727753\",\"identity\":\"rs-7727753\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}