PURPOSE: To evaluate clinical predictors of recurrence after resection of localized non-small cell lung cancer (NSCLC).
METHODS: Records of all patients undergoing resection of pathologic stage 1 and 2 NSCLC between 2000 and 2005, inclusive, were reviewed. Patient characteristics, smoking history, preoperative pulmonary function, preoperative biopsy, operative details, histology, adjuvant treatment and tumor markers were included as variables. Evidence of recurrence and survival status was determined by compiling data from electronic medical records and from the institutional Tumor Registry. Variables were compared using two-tailed Fisher exact test or independent samples student t-testing, and survival was calculated using Kaplan-Meier curves, using SPSS for Windows.
RESULTS: During the six years reviewed, 170 patients had resection of stage 1 and 2 NSCLC: 67 patients were stage 1A, 67 stage 1B, 3 stage 2A, and 33 stage 2B. Recurrences were documented in 36 patients (21%) occurring at a mean of 25.7 ± 15.2 months after resection. Recurrences were not significantly associated with: surgical stage (1A, 1B, 2A or 2B), extent of surgery (wedge, lobectomy, pneumonectomy), histology, age, active smoking or total tobacco exposure, preoperative pulmonary function, invasive preoperative biopsy (bronchoscopy, transthoracic needle biopsy, endoscopic ultrasound biopsy), treatment with adjuvant chemotherapy, or levels of serum tumor markers. Median postoperative survival was 50 months (95% confidence intervals 38-62 months), and did not differ significantly by type of resection or by pathologic stage. However, survival was significantly worse at each stage for patients with recurrent cancer compared with those without evidence of recurrence.
CONCLUSION: Recurrent cancer after resection of apparently localized NSCLC occurs in a substantial proportion of patients and is associated with worse survival. None of the clinical variables examined accurately predicted which patients are at higher risk of recurrence.
CLINICAL IMPLICATIONS: Recurrence after resection of NSCLC is associated with increased mortality, and early detection of recurrence may improve survival in these patients. Future research of the utility of intensive followup and surveillance programs after resection of NSCLC should be applied uniformly to all patients.
DISCLOSURE: Jeffrey Rubins, No Financial Disclosure Information; No Product/Research Disclosure Information