Prognostic factors and the significance of treatment after recurrence in completely resected stage I non-small cell lung cancer.
OBJECTIVE
The objective of this study was to identify the clinicopathologic factors influencing postrecurrence survival (PRS) in and the effect of postrecurrence therapy (PRT) on patients with completely resected stage I non-small cell lung cancer (NSCLC).


METHODS
We reviewed the data of 919 patients in whom complete resection of stage I NSCLC had been performed.


RESULTS
Of the 919 patients, 170 (18.5%) had recurrent disease. Initial PRT was performed in 118 patients (69.1%) (surgery in eight, chemotherapy in 79, radiotherapy in 10, and chemoradiotherapy in 21). On multivariate analyses, PRT (hazard ratio [HR], 0.542; 95% CI, 0.344-0.853; P = .008), female sex (HR, 0.487; 95% CI, 0.297-0.801; P = .005), and differentiation (HR, 1.810; 95% CI, 1.194-2.743; P = .005) demonstrated a statistically significant association with favorable PRS. Bone metastasis (HR, 3.288; 95% CI, 1.783-6.062; P &lt; .001), liver metastasis (HR, 4.518; 95% CI, 1.793-11.379; P = .001), chemotherapy (HR, 0.478; 95% CI, 0.236-0.975; P = .040), epidermal growth factor receptor-tyrosine kinase inhibitors treatment (EGFR-TKIs) (HR, 0.460; 95% CI, 0.245-0.862; P = .015), and nonadenocarcinoma (HR, 2.136; 95% CI, 1.273-3.585; P = .004) were independently and significantly associated with PRS in the 118 patients who underwent any PRT. Subgroup analysis with a combination of these five PRS factors in the patients who underwent any PRT revealed median PRS times of 42.4 months for 20 patients lacking all five risk factors and 18.8 months for 98 patients with at least one of these risk factors (P = .001).


CONCLUSIONS
PRT, sex, and differentiation were independently associated with PRS. In the patients who underwent any PRT, PRS was related to EGFR-TKIs, chemotherapy, histology, and initial recurrence sites. One challenge for the future will be to create systematic treatment strategies for recurrent NSCLC according to the risk factor status of individual patients.
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan. Electronic address: zenkyu@za3.so-net.ne.jp.
Yoshihisa
Y
Shimada
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Hisashi
H
Saji
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Koichi
K
Yoshida
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Masatoshi
M
Kakihana
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Hidetoshi
H
Honda
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Masaharu
M
Nomura
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Jitsuo
J
Usuda
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Naohiro
N
Kajiwara
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Tatsuo
T
Ohira
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Norihiko
N
Ikeda
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D008197:Lymph Node Excision; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed