Patient-Reported Outcomes of Radiofrequency Ablation versus Video-Assisted Thoracoscopic Surgery for Stage IA NSCLC: A Longitudinal Cohort Study

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.