A clinical model to estimate recurrence risk in resected stage I non-small cell lung cancer.
OBJECTIVE
There are no reliable markers to predict recurrence in resected Stage I non-small cell lung cancer (NSCLC). A validated clinical model to estimate the risk of recurrence would help select patients for adjuvant therapy.


METHODS
We reviewed the medical records of 715 patients who had a potentially curative resection for Stage I NSCLC at our institution from 1990 to 2000. Recurrence rates were estimated by the Kaplan-Meier method. A model to estimate risk of recurrence was developed by combining independent risk factors.


RESULTS
With a median follow-up of 4.7 years, the 5-year survival rates for Stages IA and IB were 66% and 55% respectively, and 5-year recurrence rates were 19% and 30%, respectively. Four factors were independently associated with tumor recurrence: tumor size >3 cm (hazard ratio [HR] = 2.4), surgery other than lobectomy (HR = 2.0), nonsquamous histology (HR = 1.4), and high-grade cellular differentiation (HR = 1.4). A scoring system for recurrence was developed by assigning 2 points for each major risk factor (tumor size and surgery) and 1 point for each minor risk factor (histologic subtype and cellular grade). Scores were grouped as low (0-1), intermediate (2-3), and high (>3), yielding 5-year estimates of risk of recurrence of 14%, 27%, and 43%, respectively.


CONCLUSIONS
This model, based upon readily available clinicopathologic characteristics, can estimate the risk of recurrence in Stage I NSCLC, independent of T classification. This model could be used to select patients for adjuvant therapy if validated in independent data sets.
Goodgame
Boone
B
Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Viswanathan
Avinash
A
Miller
C Ryan
CR
Gao
Feng
F
Meyers
Bryan
B
Battafarano
Richard J
RJ
Patterson
Alexander
A
Cooper
Joel
J
Guthrie
Tracey J
TJ
Bradley
Jeffrey
J
Pillot
Giancarlo
G
Govindan
Ramaswamy
R
D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D018287:Carcinoma, Large Cell / Q000175:diagnosis / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008954:Models, Biological; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate