Persistent excess mortality from lung cancer in patients with stage I non-small-cell lung cancer, disease-free after 5 years

Abstract

Among patients with non-small-cell lung cancer (NSCLC), those with pathological stage I have the best expectation of survival; however, survival is reduced to less than 50% in the long term. At present, it is unclear when patients can be reasonably defined as cured, and if they experience a higher incidence of malignant/nonmalignant diseases and a lower expectation of survival than the general population. A total of 134 stage I NSCLC patients, who had undergone resection at the Thoracic Surgery Unit of the General Hospital of Verona (north-eastern Italy) from October 1987 to December 1993, were still disease-free at 5 years. These subjects were further followed up, and morbidity and mortality rates were compared with those recorded in the general population of the same geographical area. The standardised incidence ratios (SIRs) for all malignancies and for lung cancer were higher than expected (2.39, 95% CI ¼ 1.6 -3.5, Po0.001; 10.1, 95% CI ¼ 6.2 -15.6, Po0.0001, respectively). The standardised mortality ratio (SMR) was also significantly increased (1.73, 95% CI ¼ 1.1 -2.6, P ¼ 0.013). The excess mortality could be entirely explained by an increase in mortality from lung cancer (5.7, 95% CI ¼ 2.8 -10.1, Po0.0001). This study shows that patients, resected for pathological stage I NSCLC and tumour-free after 5 years, have a higher incidence of new lung cancer compared with the general population, which in turn determines an excess in all-cause mortality in the following years.

3q26 Amplification and Polysomy of Chromosome 3 in Squamous Cell Lesions of the Lung: A Fluorescence In situ Hybridization Study

“…Lack of prognostic implications of 3q26 gains for lung cancer is at variance with head and neck (44,48) or cervical (57) SCC, although we have taken into account only early-stage patients' tumors (pT1-2 N0 M0), which usually show an inherently more favorable prognosis, as compared with patients with more advanced disease (76,77).…”

CD117 immunoreactivity in stage I adenocarcinoma and squamous cell carcinoma of the lung: relevance to prognosis in a subset of adenocarcinoma patients

“…35 Detailed information on the patients' cigarette smoking history was unavailable at the time of the present study. The patients' age ranged from 35 to 77 years for men (mean7s.d.…”

“…33,34 Furthermore, patients free from disease after 5 years will still show an excess of lung cancer-related mortality as compared with the referring population. 35 Therefore, unveiling the causative role of growth factor receptors in the development of earlystage adenocarcinomas or squamous cell carcinomas might offer new insights into the mechanisms of local tumor growth and distant metastases, and allow the patients to be better stratified into different risk categories or to be offered novel options of targeted therapy.…”

Critical Review of Nonsurgical Treatment Options for Stage I Non-Small Cell Lung Cancer

“…The cumulative risk for second lung tumors and other smoking-related cancer increases and reaches 15%-20% at 8 years after resection [3,17]. In cases where initial surgical treatment has led to a reduction in quality of life (QoL) or pulmonary reserve, a patient's ability to undergo curative treatment for a second tumor may be restricted.…”