SESSION TITLE: Lung Cancer Treatment & Outcomes
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM
PURPOSE: For early stage non-small cell lung cancer (NSCLC) surgery is potentially the only curative treatment, but as patients’ survival continues to improve, we have observed a high incidence of recurrence even in early stage NSCLC. We aimed to identify the predictive factors for recurrence in patients (pts) with stage I/II NSCLC.
METHODS: We reviewed the records of all pts diagnosed with stage I/II NSCLC at our institution from 2000 to 2013. Initial diagnosis at our institution and a minimum follow up of 36 months were required. Cox regression model was used for multivariate analysis.
RESULTS: A total of 673 pts with stage I/II were identified, of those 175 (26%) developed local or distant recurrence, with a median time to recurrence of 18 months. Median age was 74 years (range: 44-96), 47% were current or former smoker. Pts were more likely to have upper lobe tumors than all other tumor locations combined (58% vs 42%), adenocarcinoma was the most prevalent histologic subtype (53%) and 47% had poorly differentiated or anaplastic tumors. 152 pts (87%) received surgery with lobectomy being the most common procedure followed by wedge resection, 24% received chemotherapy and 7% radiation. Median overall survival was 26 months (95%CI: 17.2-34.5). Pts with squamous cell carcinoma had a shorter median time to recurrence when compared with adenocarcinomas (13.2 months vs. 19.7 months) (p<0.02). Smoking history (HR: 1.98, 95%CI: 1.62-2.82, p<0.007), central tumor location (HR: 1.24, 95%CI: 1.09-1.56, p<0.01), squamous subtype (HR: 1.46, 95%CI: 1.22-1.84, p<0.002) , high histologic grade (HR: 2.76, 95%CI: 1.34-5.97, p<0.01) and lymphovascular invasion (HR: 4.3, 95%CI: 3.32-5.00, p<0.001) were independent predictors of recurrence by multivariate analysis. Poorly differentiated tumors were associated with a higher frequency of distant recurrence when compared with well differentiated tumors (HR: 2.7 vs. 1.2).
CONCLUSIONS: In our cohort, we observed that pts with lymphovascular invasion have the highest recurrence risk followed by high histologic grade tumors with the former having a direct correlation with distant metastasis.
CLINICAL IMPLICATIONS: Recurrence following treatment of early stage NSCLC can be considered a multifactorial process dependent on clinicophatological, biological and treatment characteristics. Pts with these risk factors may benefit from close surveillance after surgical resection, adjuvant therapy and aggressive management of local recurrence.
DISCLOSURE: The following authors have nothing to disclose: Narjust Duma, Yulanka Castro Dominguez, Harry Harper, Martin Gutierrez
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