Background: Lung cancer is a frequent comorbidities in chronic obstructive pulmonary disease. However, the local risk of developing lung cancer related to regional emphysema distribution and clinical outcome has not been investigated. Our aim was to evaluate the impact of the regional emphysema score (RES) on tumor location and prognosis in completely resected Non-small cell lung cancer (NSCLC) patients. Patients and Methods: We enrolled 460 patients who underwent curative surgery for NSCLC at seven hospitals in The Catholic University of Korea from 2014 to 2018. Emphysema is characterized by computed tomography as area of low attenuation surrounded by normal lung attenuation. Semi-quantitative emphysema scoring was classified as follows: 0=none, 0.5=1 to 10%, 1=11 to 25%, 2=26 to 50%, 3=51 to 75%, 4=76 to 100%. RES was given to each of 6 lung zone: right and left lung: upper, middle (or lingular), lower lobes. We investigated the association between RES distribution and clinicopathologic characteristics, and its prognosis according to recurrence. Result: Among 460 patients, mean of total RES was 2.7±3.4. 160 patients had cancer in relatively high RES and the mean difference was significant in a paired t-test (0.51 vs. 0.37, p<0.001). Among them, male was common (64.4% vs 35.6%, p<0.001), and ECOG≥2 (2.2%), presence of COPD (35.4%), and smoking history (64.2%) were significantly different. In histopathology, squamous carcinoma, poorly differentiation, pleural or vascular invasion were more frequently observed in group with cancer in relatively high RES. Cancer in relatively high RES showed significantly shorter disease free survival(2430.2±142.3days vs.1921.3±194.7days, p<0.01). In cox proportional hazards model, cancer in relatively high RES (odds ratio (OR):1.56;95% confidence interval(CI):1.01-2.42, p<0.05), advanced pathologic stage≥III (OR:2.23,95% CI:1.28-3.89, p<0.01), and poorly differentiation (OR:1.99, 95%:CI:1.22-3.21, p<0.01) were independent risk factor for tumor recurrence. Conclusion: We showed RES in a lobe with cancer were significantly higher than those in a lobe without cancer. The cancer in relatively high RES were associated with smoking history, advanced pathologic stage, poorly differentiated phenotype and was an independent poor prognostic factor for recurrence in completely resected NSCLC patients.