Varying recurrence rates and risk factors associated with different definitions of local recurrence in patients with surgically resected, stage I nonsmall cell lung cancer

Abstract

BACKGROUND:The objective of this study was to examine the effects of different definitions of local recurrence on the reported patterns of failure and associated risk factors in patients who undergo potentially curative resection for stage I nonsmall cell lung cancer (NSCLC). METHODS: The study included 306 consecutive patients who were treated from 2000 to 2005 without radiotherapy. Local recurrence was defined either as ''radiation'' (r-LR) (according to previously defined postoperative radiotherapy fields), including the bronchial stump, staple line, ipsilateral hilum, and ipsilateral mediastinum; or as ''comprehensive'' (c-LR), including the same sites plus the ipsilateral lung and contralateral mediastinal and hilar lymph nodes. All recurrences that were not classified as ''local'' were considered to be distal. RESULTS: The median follow-up was 33 months. The proportions of c-LR and r-LR at 2 years, 3 years, and 5 years were 14%, 21%, and 29%, respectively, and 7%, 12%, and 16%, respectively. Significant risk factors for c-LR on multivariate analysis were diabetes, lymphatic vascular invasion, and tumor size; and significant factors for r-LR were resection of less than a lobe and lymphatic vascular invasion. The proportions of distant (nonlocal) recurrence using these definitions at 2 years, 3 years, and 5 years were 10%, 12%, and 18%, respectively, and 14%, 19%, and 29%, respectively. Significant risk factors for distant failure were histology when using the c-LR definition and tumor size when using the r-LR definition. CONCLUSIONS: Local recurrence increased nearly 2-fold when a broad definition was used instead of a narrow definition. The definition also affected which factors were associated significantly with both local and distant failure on multivariate analysis. Comparable definitions must be used when analyzing different series.

Optimising treatment for post-operative lung cancer recurrence

“…For example, 5-year loco-regional recurrence rates are between 15 and 38.5% [2], and the incidence of local recurrence in early-stage lung cancer of 10-15% [3], or a mean disease-free interval of 14.1-19.8 months, that is similar to distant recurrent disease [4]. Failure to demonstrate the advantage of complete lymphadenectomy over nodal sampling in terms of local recurrence or survival in patients operated for T1-2, N0 or T1-2, N1 disease, makes the clinical approach more complex [5].…”

“…The worse survival rates reported, for example 23% in one series, are counterweighted by the high proportion (>65%) of stage III patients. The evidence indicates better survival of patients with squamous cell versus adenocarcinoma [2] and a significant influence of disease stage (stages I and II versus stage III).…”

Local recurrence following lung cancer surgery: Incidence, risk factors, and outcomes

“…Some studies limit the definition of local recurrences to those found in the bronchial stump, staple line, ipsilateral hilum, and ipsilateral mediastinum [5]. Others have expanded this definition to include the entire ipsilateral lung and contralateral hilar and mediastinal lymph nodes [6]. Still many others provide no clear description of how local recurrence was defined in determining results.…”

Chronic Obstructive Pulmonary Disease in Stage I Non-small Cell Lung Cancer That Underwent Anatomic Resection: The Role of a Recurrence Promoter

“…Diabetes mellitus (DM) and cardiovascular diseases have been reported to place patients undergoing curative resection at higher risk of local recurrence and reduced survival (6,7). In addition, patients receiving curative surgery for their NSCLC who have co-existing chronic obstructive pulmonary disease (COPD) have worse survival than their counterparts with a better pulmonary function (8).…”