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Original Research: Lung Cancer |

Prognostic Factors and the Significance of Treatment After Recurrence in Completely Resected Stage I Non-small Cell Lung CancerPostrecurrence Survival in Non-Small Cell Cancer

Yoshihisa Shimada, MD, PhD; Hisashi Saji, MD, PhD; Koichi Yoshida, MD, PhD; Masatoshi Kakihana, MD, PhD; Hidetoshi Honda, MD, PhD; Masaharu Nomura, MD, PhD; Jitsuo Usuda, MD, PhD; Naohiro Kajiwara, MD, PhD; Tatsuo Ohira, MD, PhD; Norihiko Ikeda, MD, PhD
Author and Funding Information

From the Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.

Correspondence to: Yoshihisa Shimada, MD, PhD, Department of Surgery I, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; e-mail: zenkyu@za3.so-net.ne.jp


Funding/Support: This study was supported by grants from the Ministry of Education, Culture, Sports, Science and Technology [24592104] and the Ministry of Health, Labor and Welfare [22101601].

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


Chest. 2013;143(6):1626-1634. doi:10.1378/chest.12-1717
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Objective:  The objective of this study was to identify the clinicopathologic factors influencing postrecurrence survival (PRS) in and the effect of postrecurrence therapy (PRT) on patients with completely resected stage I non-small cell lung cancer (NSCLC).

Methods:  We reviewed the data of 919 patients in whom complete resection of stage I NSCLC had been performed.

Results:  Of the 919 patients, 170 (18.5%) had recurrent disease. Initial PRT was performed in 118 patients (69.1%) (surgery in eight, chemotherapy in 79, radiotherapy in 10, and chemoradiotherapy in 21). On multivariate analyses, PRT (hazard ratio [HR], 0.542; 95% CI, 0.344-0.853; P = .008), female sex (HR, 0.487; 95% CI, 0.297-0.801; P = .005), and differentiation (HR, 1.810; 95% CI, 1.194-2.743; P = .005) demonstrated a statistically significant association with favorable PRS. Bone metastasis (HR, 3.288; 95% CI, 1.783-6.062; P < .001), liver metastasis (HR, 4.518; 95% CI, 1.793-11.379; P = .001), chemotherapy (HR, 0.478; 95% CI, 0.236-0.975; P = .040), epidermal growth factor receptor-tyrosine kinase inhibitors treatment (EGFR-TKIs) (HR, 0.460; 95% CI, 0.245-0.862; P = .015), and nonadenocarcinoma (HR, 2.136; 95% CI, 1.273-3.585; P = .004) were independently and significantly associated with PRS in the 118 patients who underwent any PRT. Subgroup analysis with a combination of these five PRS factors in the patients who underwent any PRT revealed median PRS times of 42.4 months for 20 patients lacking all five risk factors and 18.8 months for 98 patients with at least one of these risk factors (P = .001).

Conclusions:  PRT, sex, and differentiation were independently associated with PRS. In the patients who underwent any PRT, PRS was related to EGFR-TKIs, chemotherapy, histology, and initial recurrence sites. One challenge for the future will be to create systematic treatment strategies for recurrent NSCLC according to the risk factor status of individual patients.

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