Background: There is a major deficiency of a national comprehensive thoracic oncology surgery data especially in regional and remote areas such as Tasmania1. Unique to this region is its large proportion of elderly persons. The PUNT score utilises high risk features of pleural involvement, unassignable histology, neutrophil-to-lymphocyte ratio (NLR) >3.5 and tumour size to help identify patients with node-negative NSCLC at significantly discordant risk of recurrence to their TNM staging. Lymphovascular invasion, a risk factor for recurrence, was not incorporated in this score. Methods: This retrospective analysis examined all thoracic oncology cases undergoing surgical resection at Royal Hobart Hospital (2010-2022). A subgroup analysis was done on elderly node-negative lung cancer patients. We developed the PLUNT scoring system, incorporating lymphovascular invasion into the established PUNT framework, and compared prognostic performance using Cox proportional hazards regression and Kaplan-Meier survival analysis. Results: Eighty-six elderly patients with node-negative NSCLC were analysed using the PUNT and PLUNT scoring (mean age 75.2 years, 51.2% male). PLUNT > 2.0 identified 12 high-risk patients (14.0%) with 33.3% recurrence rate, while PUNT > 1.5 identified 10 patients (11.6%) with 30.0% recurrence rate. In multivariate analysis, PLUNT > 2.0 achieved statistical significance as an independent predictor of recurrence-free survival (HR = 3.700, 95% CI: 1.033-13.252, p = 0.0456), while PUNT > 1.5 failed to reach significance (p = 0.1609). Conclusions: PLUNT scoring demonstrates superior prognostic performance over PUNT thus providing enhanced risk stratification crucial for clinical decision-making. The incorporation of lymphovascular invasion significantly improves prognostic accuracy, supporting personalized treatment approaches such as the potential role in adjuvant therapy for high-risk patients.