title: Identification of stage I non-small cell lung cancer patients at high risk for local recurrence following sublobar resection.
abstract: OBJECTIVE
  An increasing proportion of patients with stage I non-small cell lung cancer (NSCLC) is undergoing sublobar resection (L-). However, there is little information about the risks and correlates of local recurrence (LR) after such surgery, especially compared with patients undergoing lobectomy (L+).
  
  
  METHODS
  Ninety-three and 318 consecutive patients with stage I NSCLC underwent L- and L+, respectively, from 2000 to 2006. Median follow-up was 34 months.
  
  
  RESULTS
  In the L- group, the LR rates at 2, 3, and 5 years were 13%, 24%, and 40%, respectively. The risk of LR was significantly associated with tumor grade, tumor size, and T stage. The crude risk of LR was 33.8% (21 of 62) for patients whose tumors were grade ≥ 2. In the L+ group, the LR rates at 2, 3, and 5 years were 14%, 19%, and 24%, respectively. The risk of LR significantly increased with increasing tumor size, length of hospital stay, and the presence of diabetes. The L- group experienced a significant increase in failure in the bronchial stump/staple line compared with the L+ group (10% vs 3%; P = .04) and nonsignificant trends toward increased ipsilateral hilar and subcarinal failure rates.
  
  
  CONCLUSIONS
  Patients with stage I NSCLC who undergo L- have an increased risk of LR compared with patients undergoing L+, particularly when they have tumors grade ≥ 2 or tumor size &gt; 2 cm. If L- is considered, additional local therapy should be considered to reduce this risk of LR, especially with tumors grade ≥ 2 or size &gt; 2 cm.
authors.affiliation: Penn State Hershey Cancer Institute, Hershey, PA. Electronic address: jvarlotto@hmc.psu.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Varlotto
authors.affiliation: Harvard Medical School, Boston, MA.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Medford-Davis
authors.affiliation: Harvard Medical School, Boston, MA; Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Abram
authors.initials: A
authors.lastname: Recht
authors.affiliation: Department of Radiation Oncology, Pittsburgh Cancer Institute, Pittsburgh, PA.
authors.forename: John
authors.initials: J
authors.lastname: Flickinger
authors.affiliation: Department of Health Policy and Administration, Pennsylvania State University, University Park, PA.
authors.forename: Nengliang
authors.initials: N
authors.lastname: Yao
authors.affiliation: Pennsylvania State College of Medicine, Hershey, PA.
authors.forename: Clayton
authors.initials: C
authors.lastname: Hess
authors.affiliation: Penn State Heart and Vascular Institute, Hershey, PA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Reed
authors.affiliation: Penn State Hershey Pulmonary Medicine, Hershey, PA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Toth
authors.affiliation: Penn State Hershey Medical Center, Hershey, PA.
authors.forename: Dani S
authors.initials: DS
authors.lastname: Zander
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, IL.
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: DeCamp
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome