title: Risk factors for local and regional recurrence in patients with resected N0-N1 non-small-cell lung cancer, with implications for patient selection for adjuvant radiation therapy.
abstract: BACKGROUND
  The purpose of this study was to evaluate the actuarial risk of local and regional failure in patients with completely resected non-small-cell lung cancer (NSCLC), and to assess surgical and pathological factors affecting this risk.
  
  
  METHODS
  Between January 1998 and December 2009, 1402 consecutive stage I-III (N0-N1) NSCLC patients underwent complete resection without adjuvant radiation therapy. The median follow-up was 42 months.
  
  
  RESULTS
  Local-regional recurrence was identified in 9% of patients, with local failure alone in 3% of patients, regional failure alone in 4% of patients, and both local and regional failure simultaneously in 2% of patients. Patients who had local failure were found to be at increased risk of mortality. By multivariate analyses, three variables were shown to be independently significant risk factors for local [surgical procedure (single/multiple wedges+segmentectomy versus lobectomy+bilobectomy+pneumonectomy), tumor size>2.7 cm, and visceral pleural invasion] and regional (pathologic N1 stage, visceral pleural invasion, and lymphovascular space invasion, LVI) recurrence, respectively.
  
  
  CONCLUSIONS
  Patients with N0-N1 disease have low rates of locoregional recurrence after surgical resection. However, several prognostic factors can be identified that increase this risk and identify patients who may benefit from adjuvant treatment.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Lopez Guerra
authors.forename: D R
authors.initials: DR
authors.lastname: Gomez
authors.forename: S H
authors.initials: SH
authors.lastname: Lin
authors.forename: L B
authors.initials: LB
authors.lastname: Levy
authors.forename: Y
authors.initials: Y
authors.lastname: Zhuang
authors.forename: R
authors.initials: R
authors.lastname: Komaki
authors.forename: J
authors.initials: J
authors.lastname: Jaen
authors.forename: A A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: S G
authors.initials: SG
authors.lastname: Swisher
authors.forename: J D
authors.initials: JD
authors.lastname: Cox
authors.forename: Z
authors.initials: Z
authors.lastname: Liao
authors.forename: D C
authors.initials: DC
authors.lastname: Rice
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D012372:ROC Curve; D012307:Risk Factors