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Original Research |

Risk Factors for Tumor Recurrence in Patients With Early-Stage (Stage I and II) Non-small Cell Lung CancerEarly-Stage Non-small Cell Lung Cancer Recurrence: Patient Selection Criteria for Adjuvant Chemotherapy According to the Seventh Edition TNM Classification

Ryo Maeda, MD; Junji Yoshida, MD; Genichiro Ishii, MD; Tomoyuki Hishida, MD; Mitsuyo Nishimura, MD; Kanji Nagai, MD; International Association for the Study of Lung Cancer International Staging Committee
Author and Funding Information

From the Department of Thoracic Oncology (Drs Maeda, Yoshida, Hishida, Nishimura, and Nagai), and the Department of Pathology (Dr Ishii), Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.

Correspondence to: Kanji Nagai, MD, Department of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan; e-mail: knagai@east.ncc.go.jp

CEA = preoperative serum carcinoembryonic antigen level, normal upper limit at 5 ng/mL; HR = hazard ratio; NSCLC = non-small cell lung cancer; VPI = visceral pleural invasion.

a

Significant.

See Table 1 legend for expansion of abbreviations.

a

Characterstic was not included in multivariable model.

b

Significant.

See Table 1 legend for expansion of abbreviations.

a

Characterstic was not included in multivariable model.

b

Significant.

a

Significant.

For editorial comment see page 1398

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


For editorial comment see page 1398

For editorial comment see page 1398

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1494-1502. doi:10.1378/chest.10-3279
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Objectives:  The purpose of this study was to evaluate risk factors for tumor recurrence in patients with completely resected early-stage non-small cell lung cancer (NSCLC).

Methods:  Between July 1992 and December 2007, 1,967 consecutive patients with stage I and II NSCLC with diagnoses based on the seventh edition TNM classification underwent complete resection. All patients were divided into three groups according to the stage and presence of lymph node metastasis: stage I, patients with stage I, T1-T2aN0M0 disease; stage IIN0, patients with stage II, T2b-T3N0M0, node-negative disease; and stage IIN1, patients with stage II, T1-2N1M0, node-positive disease. Freedom from recurrence rate was estimated using the Kaplan-Meier method, and recurrence risk factors were identified by univariate and multivariate analyses.

Results:  The 5-year freedom from recurrence rates for stage I, stage IIN0, and stage IIN1 patients were 84%, 61%, and 54%, respectively. By multivariate analyses, three variables (histologic differentiation, vessel invasion, and visceral pleural invasion) in stage I and two variables (adenocarcinoma histology and visceral pleural invasion) in stage IIN0 and stage IIN1 were shown to be independently significant risk factors for recurrence. According to subgroup analyses that combined these risk factors in each group, the 5-year freedom from recurrence rate was 63% for stage I with three risk factors, whereas those for stage IIN0 and stage IIN1 without risk factors were 83% and 78%, respectively.

Conclusion:  In patients with stage I and II NSCLC, we identified risk factors for recurrence. When these factors are combined, high- and low-risk subgroups can be identified within each group.

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