{
  "abstract": "Objectives\n\nChronobiology may influence outcomes in non-small-cell lung cancer (NSCLC), but its prognostic role in early-stage disease remains unclear. We evaluated the association between perioperative chronobiological variables, systemic inflammation, and long-term outcomes after complete resection for stage I NSCLC.Methods\n\n587 patients who underwent curative-intent resection for pathological stage I NSCLC between 2009 and 2018 were retrospectively reviewed. Chronobiological and inflammatory variables included season of surgery (spring/summer [21st March-22nd September], autumn/winter [23rd September-20th March]), time of day, day of week, and preoperative (CRP0 levels: low ≤ 3 mg/L, high > 3 mg/L) and postoperative day-3 (CRP3 levels: low ≤ 126 mg/L, high > 126 mg/L) C-reactive protein levels. The cohort was randomly divided into training (70%) and testing (30%) sets to develop and validate a prognostic model for overall survival (OS), taking into consideration the follow-up time. Disease-free survival (DFS) was analyzed as a secondary endpoint.Results\n\nMedian follow-up was 6.7 years, with 80 deaths and 108 recurrences recorded. In the training set, older age (p = 0.0049), stage IB disease (p = 0.0301), high CRP0 (p = 0.0049), and high CRP3 (p = 0.0280) were associated with worse OS, while surgery performed during autumn/winter was associated with improved OS (p = 0.0312). The multivariate Cox model including age, stage, and season of surgery showed the best prognostic performance (C-index 0.67, 95% Bonferroni-adjusted CI 0.50-0.83) and was internally validated in the testing cohort (C-index 0.69, 95%CI 0.52-0.86). The resulting linear predictor remained associated with both OS and DFS in the overall population.Conclusions\n\nA simple model integrating age, pathological stage, and season of surgery was associated with long-term outcomes after surgery in stage I NSCLC. This model provides an exploratory framework integrating host-, tumor-, and chronobiological dimensions of prognosis. These findings require external validation and further investigation of the biological mechanisms underlying seasonal variation.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.",
    "Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.",
    "Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.",
    "Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.",
    "Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale Dei Tumori, 20133 Milan, Italy.",
    "Department of Oncology and Hemato-Oncology, University of Milan, 20133 Milan, Italy."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 18,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Giovanni Leuzzi",
      "orcid": "0000-0003-2773-0524"
    },
    {
      "affs": [
        1
      ],
      "name": "Pamela Minicozzi"
    },
    {
      "affs": [
        1
      ],
      "name": "Paolo Verderio",
      "orcid": "0000-0002-9231-1281"
    },
    {
      "affs": [
        1
      ],
      "name": "Chiara Maura Ciniselli",
      "orcid": "0000-0003-4488-885X"
    },
    {
      "affs": [
        0
      ],
      "name": "Michele Ferrari",
      "orcid": "0000-0002-2661-9317"
    },
    {
      "affs": [
        0
      ],
      "name": "Alessandro Pardolesi",
      "orcid": "0000-0002-7037-402X"
    },
    {
      "affs": [
        0
      ],
      "name": "Alessia Stanzi",
      "orcid": "0000-0001-8569-650X"
    },
    {
      "affs": [
        0
      ],
      "name": "Jury Brandolini",
      "orcid": "0000-0002-5505-8758"
    },
    {
      "affs": [
        0
      ],
      "name": "Luigi Rolli",
      "orcid": "0000-0002-6673-5785"
    },
    {
      "affs": [
        0
      ],
      "name": "Matteo Calderoni",
      "orcid": "0009-0000-0958-7846"
    },
    {
      "affs": [
        0
      ],
      "name": "Clarissa Uslenghi"
    },
    {
      "affs": [
        2
      ],
      "name": "Ugo Pastorino"
    },
    {
      "affs": [
        3
      ],
      "name": "Giuseppe Lo Russo"
    },
    {
      "affs": [
        3
      ],
      "name": "Claudia Proto"
    },
    {
      "affs": [
        3
      ],
      "name": "Arsela Prelaj",
      "orcid": "0000-0002-3863-088X"
    },
    {
      "affs": [
        3
      ],
      "name": "Teresa Beninato",
      "orcid": "0000-0003-0388-6655"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Daniele Lorenzini",
      "orcid": "0000-0002-1425-3354"
    },
    {
      "affs": [
        0
      ],
      "name": "Piergiorgio Solli",
      "orcid": "0000-0002-4890-2578"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3g9gvmp5qr2ge.bib",
  "cited_by": 0,
  "doi": "10.3390/cancers18193208",
  "fulltext_url": "https://europepmc.org/articles/PMC13664035",
  "id": "3g9gvmp5qr2ge",
  "issns": [
    "2072-6694"
  ],
  "landing_url": "https://europepmc.org/article/MED/42882902",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Lung Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7220423181",
  "pdf_url": "https://europepmc.org/articles/PMC13664035?pdf=render",
  "pmcid": "PMC13664035",
  "pmid": "42882902",
  "published": "2026-10-04",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/3g9gvmp5qr2ge.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:00Z",
      "native_id": "MED:42882902",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42882902"
    },
    {
      "first_seen": "2026-10-30T12:19:58Z",
      "native_id": "10.3390/cancers18193208",
      "source": "crossref",
      "url": "https://www.mdpi.com/2072-6694/18/19/3208"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2072-6694",
      "subfield": "oncology"
    }
  ],
  "title": "A Chronobiological Prognostic Model for Resected Stage I Non-Small-Cell Lung Cancer.",
  "title_text": "A Chronobiological Prognostic Model for Resected Stage I Non-Small-Cell Lung Cancer.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:58Z",
  "url": "https://research.draconitic.com/paper/3g9gvmp5qr2ge",
  "venue": "Cancers",
  "versions": []
}