Postrecurrence survival in patients with stage I non-small cell lung cancer

• Published in: European journal of cardio-thoracic surgery 2008-09, Vol.34 (3), p.499-504
• Main Authors: Nakagawa, Tatsuo, Okumura, Norihito, Ohata, Keiji, Igai, Hitoshi, Matsuoka, Tomoaki, Kameyama, Kotaro
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - surgery; Cardiology. Vascular system; Combined Modality Therapy; Epidemiologic Methods; Female; Humans; Liver Neoplasms - secondary; Liver Neoplasms - therapy; Lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision; Lymphatic Metastasis; Male; Medical sciences; Metastasis; Middle Aged; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Pneumology; Prognosis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival analysis; Treatment Outcome; Tumors of the respiratory system and mediastinum
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2008.05.016

Objective: Postoperative recurrence is a major obstacle to achieving a cure and long-term survival in patients with non-small lung cancer. However, prognostic factors and the efficacy of therapy after recurrence remain controversial. We evaluated the clinical outcomes of patients with resected lung cancer for postrecurrence prognostic factors. Methods: Patients who underwent complete resection with systematic lymph node dissection for stage I non-small cell lung cancer were selected. Cases of low-grade malignancy, preoperative therapy, history of previous malignancy or death within 30 days of operation were excluded. A total of 397 patients were retrospectively reviewed. Results: Out of 87 patients who had recurrence after surgery, 45 had symptoms at the initial recurrence. The initial recurrent site was local in 30 patients and distant in 57. Single-site recurrence was detected in 48 patients and multiple-site recurrence was seen in 39. The recurrent site was the ipsilateral thorax in 49 patients, the contralateral thorax in 32, the cervico-mediastinum in 15, brain in 12 and bone in 11. Surgery was performed in 20 patients, whereas non-surgical therapy was performed in 55 (chemotherapy, 16; radiation therapy, 33; chemo-radiation therapy, 6). Prognostic analysis of factors related to recurrent status demonstrated that symptoms at the initial recurrence, cervico-mediastinal metastasis, liver metastasis and postrecurrence therapy were significant prognostic factors in both univariate and multivariate analysis. Conclusions: Symptoms at the initial recurrence, cervico-mediastinal metastasis and liver metastasis were worse prognostic factors after recurrence. Postrecurrence therapy for the initial recurrence may prolong survival after recurrence.