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Local recurrence after surgery for early stage lung cancer
Cancer, 08/19/09

Kelsey CR et al. – In a trial to evaluate the actuarial risk of local failure (LF) after surgery for stage I to II non–small cell lung cancer (NSCLC) and assess surgical and pathologic factors affecting this risk, it was concluded that greater than half of disease recurrences after surgery for early stage NSCLC involved local sites. Pathologic factors may help to distinguish those pts at highest risk.

Methods

The records, including pertinent radiologic studies, of all pts who underwent surgery for T1 to T2, N0 to N1 NSCLC were reviewed.
Risks of disease recurrence were estimated using the Kaplan-Meier method.
A multivariate Cox regression analysis assessed factors associated with LF in the entire cohort and a subgroup undergoing optimal surgery for stage IB to II disease.

Results

For all 975 consecutive pts, 5-yr actuarial risk of local and/or distant disease recurrence was 36%.
First sites of failure were local only (25%), local and distant (29%), and distant only (46%).
5-yr actuarial risk of LF was 23%.
Squamous/large cell histology, and sublobar resections were found to be independently associated with a higher risk of LF.
For 445 pts, undergoing at least a lobectomy with negative surgical margins and currently considered for adjuvant chemotherapy (stage IB-II disease), 5-yr actuarial risk of LF was 27%.
In this subgroup, squamous/large cell histology (HR, 2.5) and lymphovascular space invasion (HR, 1.74) were associated with higher risk of LF.
5-yr rate of LF was 13%, 32%, and 47%, respectively, with 0, 1, or 2 risk factors.

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