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Original Research: Lung Cancer |

Risk Factors for Recurrence After Lung Cancer Resection as Estimated Using the Survival Tree MethodRisk Factors for Recurrence After Lung Resection

Shigeki Sawada, MD, PhD; Natsumi Yamashita, MD, PhD; Hiroshi Suehisa, MD, PhD; Motohiro Yamashita, MD, PhD
Author and Funding Information

From the Department of Thoracic Surgery (Drs Sawada, Suehisa, and M. Yamashita), and the Division of Clinical Biostatistics (Dr N. Yamashita), National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.

Correspondence to: Shigeki Sawada, MD, PhD, Department of Thoracic Surgery, Shikoku Cancer Center, 160 Minamiumemoto-cho Kou, Matsuyama-shi, Ehime, 791-0280, Japan; e-mail: ssawada@shikoku-cc.go.jp


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. See online for more details.


Chest. 2013;144(4):1238-1244. doi:10.1378/chest.12-3034
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Background:  Patients with lung cancer often present with recurrence, even after resection. The identification of risk factors for recurrence after resection is useful.

Methods:  Among 1,338 patients with lung cancer who underwent a complete resection, 277 developed recurrences post surgery. Data regarding the TNM factors, histologic subtype, and presence/absence of vessel invasion were analyzed retrospectively using the survival tree method to identify groups with a high risk of recurrence after resection.

Results:  The results revealed that the T factor, the N factor, and lymphatic (ly) and blood (v) vessel invasion were related to the risk of recurrence, and six combinations of these factors were identified using the survival tree method: group A: v = 0, T ≤ 1b, ly = 0; group B: v = 0, T ≤ 1b, ly ≥ 1; group C: v = 0, T ≥ 2a; group D: v ≥ 1, N ≤ 1, T ≤ 2b; group E: v ≥ 1, N ≤ 1, T ≥ 3; and group F: v ≥ 1, N ≥ 2. The six groups were then further classified into three groups: a low-risk group (group A), a moderate-risk group (groups B, C, and D), and a high-risk group (groups E and F). The 5-year recurrence-free survival rate was approximately 98% for the low-risk group, 75% for the moderate-risk group, and 30% for the high-risk group.

Conclusions:  Combining the T, N, v, and ly factors allowed the precise identification of a group with a high risk of recurrence after resection.

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