Original Research: Lung Cancer |

Identification of Stage I Non-small Cell Lung Cancer Patients at High Risk for Local Recurrence Following Sublobar ResectionSublobar Resection at High Risk for Recurrence

John M. Varlotto, MD; Laura N. Medford-Davis, MD; Abram Recht, MD; John Flickinger, MD; Nengliang Yao, PhD; Clayton Hess, MD; Michael F. Reed, MD, FCCP; Jennifer Toth, MD; Dani S. Zander, MD, FCCP; Malcolm M. DeCamp, MD, FCCP
Author and Funding Information

From the Penn State Hershey Cancer Institute (Dr Varlotto); Pennsylvania State College of Medicine (Dr Hess); Penn State Heart and Vascular Institute (Dr Reed); Penn State Hershey Pulmonary Medicine (Dr Toth); and Penn State Hershey Medical Center (Dr Zander), Hershey, PA; Harvard Medical School (Drs Medford-Davis and Recht), Boston, MA; Department of Radiation Oncology (Dr Recht), Beth Israel Deaconess Medical Center, Boston, MA; Department of Radiation Oncology (Dr Flickinger), Pittsburgh Cancer Institute, Pittsburgh, PA; Department of Health Policy and Administration (Dr Yao), Pennsylvania State University, University Park, PA; and Division of Thoracic Surgery (Dr DeCamp), Department of Surgery, Northwestern Memorial Hospital, Chicago, IL.

Correspondence to: John M. Varlotto, MD, Penn State Hershey Cancer Institute, Radiation Oncology – CH63, 500 University Dr, PO Box 850, Hershey, PA 17033-0850; e-mail: jvarlotto@hmc.psu.edu

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

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;143(5):1365-1377. doi:10.1378/chest.12-0710
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Objective:  An increasing proportion of patients with stage I non-small cell lung cancer (NSCLC) is undergoing sublobar resection (L−). However, there is little information about the risks and correlates of local recurrence (LR) after such surgery, especially compared with patients undergoing lobectomy (L+).

Methods:  Ninety-three and 318 consecutive patients with stage I NSCLC underwent L− and L+, respectively, from 2000 to 2006. Median follow-up was 34 months.

Results:  In the L− group, the LR rates at 2, 3, and 5 years were 13%, 24%, and 40%, respectively. The risk of LR was significantly associated with tumor grade, tumor size, and T stage. The crude risk of LR was 33.8% (21 of 62) for patients whose tumors were grade ≥ 2. In the L+ group, the LR rates at 2, 3, and 5 years were 14%, 19%, and 24%, respectively. The risk of LR significantly increased with increasing tumor size, length of hospital stay, and the presence of diabetes. The L− group experienced a significant increase in failure in the bronchial stump/staple line compared with the L+ group (10% vs 3%; P = .04) and nonsignificant trends toward increased ipsilateral hilar and subcarinal failure rates.

Conclusions:  Patients with stage I NSCLC who undergo L− have an increased risk of LR compared with patients undergoing L+, particularly when they have tumors grade ≥ 2 or tumor size > 2 cm. If L− is considered, additional local therapy should be considered to reduce this risk of LR, especially with tumors grade ≥ 2 or size > 2 cm.

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