Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer.
BACKGROUND
Although a minimal follow-up with periodic clinic visits and chest radiographs is usually recommended after complete operation for non-small cell lung cancer, the ideal follow-up has not been defined yet. Objectives of this prospective study were to determine the feasibility of an intensive surveillance program and to analyze its influence on patient survival.


METHODS
Follow-up consisted of physical examination and chest roentgenogram every 3 months and fiberoptic bronchoscopy and thoracic computed tomographic scan with sections of the liver and adrenal glands every 6 months. Influence of patient and recurrence characteristics on survival from recurrence was successively analyzed using the log-rank test and a Cox model adjusted for treatment.


RESULTS
Among the 192 eligible patients, recurrence developed in 136 patients (71%) and was asymptomatic in 36 patients (26%). In 35 patients, recurrence was asymptomatic and detected by a scheduled procedure: thoracic computed tomographic scan in 10 (28%) patients and fiberoptic bronchoscopy in 10. Fifteen patients (43%) had a thoracic recurrence treated with curative intent. From the date of recurrence, 3-year survival was 13% in all patients and 31% in asymptomatic patients whose recurrence was detected by a scheduled procedure. Asymptomatic recurrences (p < 0.001), female sex (p < 0.001), performance status 2 or less (p = 0.01), and age 61 years or younger (p = 0.01) were shown to be significantly favorable prognostic factors.


CONCLUSIONS
This intensive follow-up is feasible and may improve survival by detecting recurrences after surgery for non-small cell lung cancer at an asymptomatic stage.
Westeel
V
V
Chest Disease Department, University Hospital, Besançon, France. virginie.westeel@ufc-chu.univ-fcomte.fr
Choma
D
D
Clément
F
F
Woronoff-Lemsi
M C
MC
Pugin
J F
JF
Dubiez
A
A
Depierre
A
A
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011013:Pneumonectomy; D012086:Reoperation; D015996:Survival Rate