Elsevier

The Annals of Thoracic Surgery

Volume 98, Issue 5, November 2014, Pages 1755-1761
The Annals of Thoracic Surgery

Original article
General thoracic
Differences in Patterns of Recurrence in Early-Stage Versus Locally Advanced Non-Small Cell Lung Cancer

Presented at the Fiftieth Annual Meeting of The Society of Thoracic Surgeons, Orlando, FL, Jan 25–29, 2014.
https://doi.org/10.1016/j.athoracsur.2014.05.070Get rights and content

Background

The benefits of screening for non-small cell lung cancer (NSCLC) have been established for high-risk individuals, and recent guidelines advocate continued surveillance after curative therapy. Yet the optimal posttreatment surveillance strategy remains to be determined. We compared patterns of recurrence and modes of detection in surgically treated patients with pathologic early-stage and locally advanced NSCLC.

Methods

Consecutive patients who had undergone resection for stage I–IIIA NSCLC from 2004 to 2009 were identified from a prospectively maintained institutional database. All patients received interval chest computed tomography (CT) scans every 6 to 12 months after treatment.

Results

In total, 1,640 patients were identified: 181 of 346 patients with stage IIIA NSCLC (52%) and 257 of 1,294 patients with stage I–II NSCLC (20%) experienced recurrences. Surveillance CT detected asymptomatic recurrences in 157 stage I–II patients (61%) and 89 stage IIIA patients (49%) (p = 0.045). Symptoms led to detection of recurrences more often in stage IIIA patients (73, 40%) than in stage I–II patients (81, 32%). Distant recurrences were more common in stage IIIA patients than in stage I–II patients (153, 85%, vs 190, 74%; p = 0.01). In stage IIIA patients, the risk of recurrence was highest during the first 2 years after operation, but it remained substantial into year 4.

Conclusions

Stage IIIA patients had fewer recurrences detected by surveillance CT, a higher rate of symptomatic presentation, a markedly higher risk of recurrence, and a higher propensity for distant recurrence. Surveillance strategies may need to account for stage-specific differences.

Section snippets

Patients and Methods

A retrospective review of a prospectively maintained database was performed. Patients who underwent complete surgical resection for stage IIIA NSCLC from January 2004 to December 2009 and who had evaluable data on recurrence status were included in the study. Staging was based on the seventh edition of the American Joint Committee on Cancer staging system [9]. Baseline patient characteristics and treatments were obtained from the database. Inasmuch as some patients had undergone neoadjuvant

Results

For the analysis of stage IIIA patients, a total of 346 patients received follow-up care for a median of 35 months (range, 3 to 92 months). Baseline characteristics are summarized in Table 1. More than half of the patients (195, 56%) underwent neoadjuvant therapy, most commonly chemotherapy alone. Approximately half of these patients (101, 51%) had final pathologic stage IIIA disease, whereas the remaining patients were downstaged. Less than half of all patients (151, 44%) had pathologic stage

Comment

Marked differences were found in the postresection patterns of recurrence between patients with locally advanced NSCLC and those with early-stage disease. The rate of recurrence was considerably higher for the stage IIIA cohort, peaking during the first 2 years; it was sustained, however, throughout the first 4 years for both cohorts. More than half of the stage IIIA patients experienced recurrences, the vast majority of which were distant metastases, most commonly in the brain. By comparison,

References (22)

Cited by (79)

View all citing articles on Scopus
View full text