Postoperative follow-up strategy based on recurrence dynamics for non-small-cell lung cancer

• Published in: European journal of cardio-thoracic surgery 2016-06, Vol.49 (6), p.1624-1631
• Main Authors: Watanabe, Katsuya, Tsuboi, Masahiro, Sakamaki, Kentaro, Nishii, Teppei, Yamamoto, Taketsugu, Nagashima, Takuya, Ando, Kohei, Ishikawa, Yoshihiro, Woo, Tekkan, Adachi, Hiroyuki, Kumakiri, Yutaka, Maehara, Takamitsu, Nakayama, Haruhiko, Masuda, Munetaka
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - surgery; Female; Follow-Up Studies; Humans; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Staging; Pneumonectomy - methods; Population Surveillance - methods; Postoperative Care - methods; Postoperative Period; Sex Factors; Thoracic Surgery, Video-Assisted - methods; Young Adult
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezv462

OBJECTIVES Our study was designed to visually represent recurrence patterns after surgery for non-small-cell lung cancer (NSCLC) with the use of event dynamics and to clarify postoperative follow-up methods based on the times of recurrence. METHODS A total of 829 patients with NSCLC who underwent complete pulmonary resection from 2005 to 2007 in 9 hospitals affiliated with the Yokohama Consortium of Thoracic Surgeons were studied. Event dynamics, based on the hazard rate, were evaluated. Only first events involving the development of distant metastases, local recurrence or both were considered. The effects of sex, histological type, pathological stage and age were studied. RESULTS The hazard rate curve displayed an initial surge that peaked about 6–8 months after surgery. The next distinct peak was noted at the end of the second year of follow-up. On non-parametric kernel smoothing, the maximum peak was found 6–8 months after surgery in men. In women, the highest peak occurred 22–24 months after surgery, which was about 16 months later than the peak in men. The peak timing of the hazard curve was not affected by histological type, pathological stage or age in either sex. CONCLUSIONS Our results suggest that the timing of recurrence after surgery for lung cancer is characterized by a bimodal pattern, and the times with the highest risk of recurrence were suggested to differ between men and women. Postoperative follow-up strategies should be based on currently recommended follow-up programmes, take into account the recurrence patterns of lung cancer, and be modified as required to meet the needs of individual patients.