Background: We conducted this study to indentify the association of initial symptoms and spirometric values with survival in patients with non small cell lung cancer. Methods: We retrospectively reviewed a prospective database of patients with NSCLC from a St. Paul`s Hospital, The Catholic University of Korea. Pretreatment variables including symptoms at presentation and baseline spirometric values were analyzed for the assessment of survival outcomes. Results: 410 patients were enrolled in this study. 283 (69.0%) patients visited to our hospital for respiratory symptoms at presentation, 70 (18.4%) patients for non-respiratory symptoms, and 27 (7.1%) patients for chest radiograph abnormalities without symptoms. The initial mean FEV1 value was 79.81±25.75%, FEV1/FVC 67.23±12.19%. Patients who visited to our hospital for respiratory or non-respiratory symptoms at presentation showed significantly decreased overall survival compared to asymptomatic patients (median, 10.0±0.96 months vs. 30.0±9.42 months; p=0.002). As the FEV1 declined, the overall survival decreased significantly (p＜0.001), and patients with an FEV1/FVC ratio less than 0.7 showed poorer outcome than greater or equal to the ratio 0.7 (median, 10.0±1.14 months vs 15.0±2.29 months, p=0.013). In multivariate analysis, patient`s symptomatic complaint at presentation was a significant factor for affecting the overall survival (OR: 1.70; 95% CI: 1.03, 2.81, p=0.037). Conclusion: Respiratory or non-respiratory symptomatic complaint at presentation is an important prognostic factor for patients with NSCLC. Background: We conducted this study to indentify the association of initial symptoms and spirometric values with survival in patients with non small cell lung cancer. Methods: We retrospectively reviewed a prospective database of patients with NSCLC from a St. Paul`s Hospital, The Catholic University of Korea. Pretreatment variables including symptoms at presentation and baseline spirometric values were analyzed for the assessment of survival outcomes. Results: 410 patients were enrolled in this study. 283 (69.0%) patients visited to our hospital for respiratory symptoms at presentation, 70 (18.4%) patients for non-respiratory symptoms, and 27 (7.1%) patients for chest radiograph abnormalities without symptoms. The initial mean FEV1 value was 79.81±25.75%, FEV1/FVC 67.23±12.19%. Patients who visited to our hospital for respiratory or non-respiratory symptoms at presentation showed significantly decreased overall survival compared to asymptomatic patients (median, 10.0±0.96 months vs. 30.0±9.42 months; p=0.002). As the FEV1 declined, the overall survival decreased significantly (p＜0.001), and patients with an FEV1/FVC ratio less than 0.7 showed poorer outcome than greater or equal to the ratio 0.7 (median, 10.0±1.14 months vs 15.0±2.29 months, p=0.013). In multivariate analysis, patient`s symptomatic complaint at presentation was a significant factor for affecting the overall survival (OR: 1.70; 95% CI: 1.03, 2.81, p=0.037). Conclusion: Respiratory or non-respiratory symptomatic complaint at presentation is an important prognostic factor for patients with NSCLC.