title: Relevance of an extensive follow-up after surgery for nonsmall cell lung cancer.
abstract: There are no international guidelines for an appropriate and cost-effective follow-up for resected nonsmall cell lung cancer (NSCLC). We retrospectively reviewed the outcome of NSCLC patients after curative surgery. Follow-up included physical examination and chest radiography every 3 months, and chest computed tomography (CT) scan, bronchoscopy, abdominal ultrasound, brain CT scan and bone scan every 6 months for 3 years, then every year over the following 2 years. Prognostic factors and costs were analysed. Median overall survival following surgery for NSCLC in 162 patients was 38.5 months. Recurrence occurred in 85 (52.5%) patients including 41 (48%) symptomatic subjects. Disease-free survival was similar between patients with asymptomatic recurrence versus symptomatic patients (11.4 versus 12 months; p=0.41). Recurrence was detected by physical examination or chest radiography in 47 (55.3%) patients. Curative-intent therapy was provided in 18 (41%) out of 44 patients with asymptomatic recurrence and in four (10%) out of 41 symptomatic cases (p=0.001). Median overall survival from time of recurrence was higher in asymptomatic patients than in symptomatic patients (15.5 versus 7.2 months; p=0.001). The cost per year of life gained was USD32 700 (€22 397). An extensive follow-up, with acceptable cost, may improve the outcome of patients with resected NSCLC through detection of asymptomatic recurrences; however, validation by prospective studies is required.
authors.affiliation: Lille University Hospital (CHRU), Lille.
authors.forename: Delphine
authors.initials: D
authors.lastname: Gourcerol
authors.forename: Arnaud
authors.initials: A
authors.lastname: Scherpereel
authors.forename: Stephane
authors.initials: S
authors.lastname: Debeugny
authors.forename: Henri
authors.initials: H
authors.lastname: Porte
authors.forename: Alexis B
authors.initials: AB
authors.lastname: Cortot
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Lafitte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000401:mortality / Q000601:surgery*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography