At present，the domestic and international lung cancer screening guidelines recommend the use of low - dose spiral computed tomography（LDCT）for lung cancer screening，which significantly improved the detection rate of early - stage lung adenocarcinoma. According to the recommendation of the Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer（2024 edition），patients with stage ⅠA（T1a/b/cN0）lung adenocarcinoma who undergo surgery with negative surgical margins（R0）can be followed up regularly after surgery without adjuvant therapy（classⅠrecommendation，evidence-based）. Recent clinical studies have revealed that the prognosis of patients with stage ⅠA lung adenocarcinoma who only receive surgical treatment is influenced by multiple factors. Although no unified treatment standard has been established，the issue of whether postoperative adjuvant therapy is necessary is still of great research value. This article reviewed the impact of factors such as tumor size，solid component ratio，micropapillary and solid subtype proportions，lymphovascular invasion（LVI），and the presence of spread through air spaces（STAS）on the prognosis of stageⅠA lung adenocarcinoma，and discussed the latest postoperative adjuvant treatment plans and their outcomes，providing new insights into the postoperative treatment of stageⅠA lung adenocarcinoma.