title: Differences in patterns of recurrence in early-stage versus locally advanced non-small cell lung cancer.
abstract: BACKGROUND
  The benefits of screening for non-small cell lung cancer (NSCLC) have been established for high-risk individuals, and recent guidelines advocate continued surveillance after curative therapy. Yet the optimal posttreatment surveillance strategy remains to be determined. We compared patterns of recurrence and modes of detection in surgically treated patients with pathologic early-stage and locally advanced NSCLC.
  
  
  METHODS
  Consecutive patients who had undergone resection for stage I-IIIA NSCLC from 2004 to 2009 were identified from a prospectively maintained institutional database. All patients received interval chest computed tomography (CT) scans every 6 to 12 months after treatment.
  
  
  RESULTS
  In total, 1,640 patients were identified: 181 of 346 patients with stage IIIA NSCLC (52%) and 257 of 1,294 patients with stage I-II NSCLC (20%) experienced recurrences. Surveillance CT detected asymptomatic recurrences in 157 stage I-II patients (61%) and 89 stage IIIA patients (49%) (p=0.045). Symptoms led to detection of recurrences more often in stage IIIA patients (73, 40%) than in stage I-II patients (81, 32%). Distant recurrences were more common in stage IIIA patients than in stage I-II patients (153, 85%, vs 190, 74%; p=0.01). In stage IIIA patients, the risk of recurrence was highest during the first 2 years after operation, but it remained substantial into year 4.
  
  
  CONCLUSIONS
  Stage IIIA patients had fewer recurrences detected by surveillance CT, a higher rate of symptomatic presentation, a markedly higher risk of recurrence, and a higher propensity for distant recurrence. Surveillance strategies may need to account for stage-specific differences.
authors.affiliation: Department of Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Feiran
authors.initials: F
authors.lastname: Lou
authors.affiliation: Department of Epidemiology and Biostatistics, Biostatistics Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Camelia S
authors.initials: CS
authors.lastname: Sima
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: huangj@mskcc.org.
authors.forename: James
authors.initials: J
authors.lastname: Huang
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed
references.citation: N Engl J Med. 2011 Aug 4;365(5):395-409
references.pmid: 21714641
references.citation: J Thorac Oncol. 2007 Aug;2(8):706-14
references.pmid: 17762336
references.citation: J Clin Oncol. 2013 Mar 20;31(9):1130-3
references.pmid: 23358986
references.citation: Ann Thorac Surg. 2013 Mar;95(3):1112-21
references.pmid: 23352418
references.citation: Rev Mal Respir. 2007 May;24(5):645-52
references.pmid: 17519819
references.citation: Ann Thorac Surg. 2000 Oct;70(4):1185-90
references.pmid: 11081867
references.citation: Arch Surg. 2002 Aug;137(8):935-8; discussion 938-40
references.pmid: 12146993
references.citation: Ann Thorac Surg. 2007 Feb;83(2):409-17; discussioin 417-8
references.pmid: 17257962
references.citation: Ann Thorac Surg. 2011 Nov;92(5):1826-32; discussion 1832
references.pmid: 22051278
references.citation: CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300
references.pmid: 20610543
references.citation: Ann Thorac Surg. 1995 Dec;60(6):1563-70; discussion 1570-2
references.pmid: 8787445
references.citation: J Thorac Cardiovasc Surg. 2012 Jul;144(1):25-32
references.pmid: 22710038
references.citation: Am J Nucl Med Mol Imaging. 2013 Sep 19;3(5):408-16
references.pmid: 24116349
references.citation: J Thorac Cardiovasc Surg. 2013 Jan;145(1):75-81; discussion 81-2
references.pmid: 23127371
references.citation: J Thorac Oncol. 2011 Dec;6(12):1993-2004
references.pmid: 21892108
references.citation: Ann Thorac Surg. 2012 Jun;93(6):1813-20; discussion 1820-1
references.pmid: 22542070
references.citation: J Thorac Oncol. 2007 Apr;2(4):273-81
references.pmid: 17409797
references.citation: J Thorac Cardiovasc Surg. 1975 Oct;70(4):606-12
references.pmid: 170482
references.citation: Chest. 2013 May;143(5 Suppl):e437S-e454S
references.pmid: 23649451
references.citation: J Thorac Oncol. 2012 Apr;7(4):723-30
references.pmid: 22425921