Tuberc Respir Dis.  2015 Oct;78(4):341-348. 10.4046/trd.2015.78.4.341.

Predictors of Recurrence after Curative Resection in Patients with Early-Stage Non-Small Cell Lung Cancer

• Lee SH
• Jo EJ
• Eom JS
• Mok JH
• Kim MH
• Lee K
• Kim KU
• Park HK
• Lee CH
• Kim YD
• Lee MK

• KMID: 2320703
• DOI: http://doi.org/10.4046/trd.2015.78.4.341

Abstract

BACKGROUND
There have been various results from studies concerning the predictors of recurrence in early-stage nonsmall cell lung cancer (NSCLC). Therefore, an accurate assessment is needed to guide effective adjuvant therapy. We investigated the predictors of a recurrence in patients with resected, early-stage NSCLC and the risk factors associated with locoregional or distant recurrence.
METHODS
This retrospective study was conducted on patients at the Pusan National University Hospital from January 2006 to December 2011. Patients with pathological stages I or II were included in this study, as based on the seventh edition TNM staging system. Multivariate Cox proportional hazard models were used to identify factors associated with recurrence.
RESULTS
Two hundred and forty-nine patients were included. Among them, 180 patients were stage I, and 69 were stage II. Overall, by multivariate analysis, the independent factors associated with a 5-year total recurrence were the presence of visceral pleural invasion (VPI) (p=0.018) and maximal standardized uptake values (SUVs) of tumors on positron emission tomography (PET) >4.5 (p=0.037). The VPI was the only independent risk factor associated with both locoregional and distant recurrence, in the analysis of the patterns of tumor recurrence and their risk factors. In the subgroup analysis of stage I patients, three variables (male, VPI and resection margin positive) were significantly associated with a 5-year recurrence.
CONCLUSION
The independent factors associated with postoperative recurrence in early-stage NSCLC were as follows: PET SUV >4.5 and the presence of VPI. For patients with those factors adjuvant therapy should be recommended as a more efficacious treatment.

Keyword

Recurrence; Carcinoma, Non-Small-Cell Lung; Drug Therapy; Adjuvants

MeSH Terms

Busan
Carcinoma, Non-Small-Cell Lung*
Drug Therapy
Humans
Multivariate Analysis
Neoplasm Staging
Positron-Emission Tomography
Proportional Hazards Models
Recurrence*
Retrospective Studies
Risk Factors

Figure

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  Figure 1 Flowchart of patient enrollment into the study.

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  Figure 2 Cumulative risk of recurrence (Kaplan-Meier curves) in entire population (249 patients). The estimated risk of recurrence was 17.5% at 2 years and 33.5% at 5 years after surgery. 5YRR: 5-year recurrence rate.

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  Figure 3 Kaplan-Meier curves for the recurrence according to the clinical factors in total patients. (A) Positron emission tomography (PET) standardized uptake value (SUV) (log-rank, 13.525; p<0.001). (B) Visceral pleural invasion (log-rank, 20.146; p<0.001). 5YRR: 5-year recurrence rate.

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