Predictive value of miR-21 and miR-486 in clock-guided minimally invasive surgery for pulmonary nodules.

OBJECTIVE: This study evaluated the prognostic significance of miR-21 and miR-486 expression in patients undergoing clock-guided minimally invasive surgery for pulmonary nodules. METHODS: In this prospective cohort study, intraoperative tissues from 138 lung cancer patients were analyzed. MiRNA expression was quantified via RT-qPCR, and patients were stratified into high- and low-expression groups using ROC-determined cutoffs. Postoperative outcomes, including residual nodule characteristics and survival, were monitored. RESULTS: At 6 months postoperatively, the high-expression group demonstrated significantly larger residual nodules (1.06 vs. 0.73 cm, p < 0.001), higher density (p = 0.003), and elevated metabolic activity (p = 0.014). This group also experienced shorter median overall survival (OS) (17.4 vs. 21.6 months, p = 0.003) and progression-free survival (PFS) (11.5 vs. 16.6 months, p = 0.012). In multivariable analysis, both miR-21 (HR = 1.75, p = 0.023) and miR-486 (HR = 1.68, p = 0.031) remained independent predictors of poor OS after adjusting for clinical covariates. CONCLUSION: Elevated miR-21 and miR-486 expression predicts aggressive tumor behavior and poor survival after precise nodule resection, highlighting their potential as biomarkers for postoperative risk stratification.