Early recurrence after surgical resection in patients with pathological stage I non-small cell lung cancer

• Published in: The Thoracic and cardiovascular surgeon Vol. 57; no. 8; p. 472
• Main Authors: Kawachi, R, Tsukada, H, Nakazato, Y, Takei, H, Furuyashiki, G, Koshi-ishi, Y, Goya, T
• Format: Journal Article
• Language: English
• Published: Germany 01-12-2009
• Subjects: Aged; Carcinoembryonic Antigen - analysis; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - surgery; Epidemiologic Methods; Female; Humans; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymphatic Metastasis; Male; Neoplasm Recurrence, Local; Neoplasm Staging; Pleural Neoplasms - secondary; Pneumonectomy - methods; Prognosis; Survival Rate - trends; Time Factors; Treatment Outcome; Vascular Neoplasms - secondary
• ISSN: 1439-1902
• DOI: 10.1055/s-0029-1185734

Early recurrence is observed even in patients who undergo complete resection and had pathological (p-) stage I. Therefore, we focused on early recurrence, and attempted to elucidate the relationship between early recurrence and clinicopathological factors.
Between May 1993 and December 2005, 1201 patients with non-small cell lung cancer (NSCLC) underwent surgical treatment at our institution. Of these, 402 patients who underwent complete resection and had p-stage I NSCLC were retrospectively analyzed for clinicopathological factors. Patients were divided into four groups according to the period between surgery and recurrence (R): no recurrence (NR, n = 331), late recurrence (LR, n = 28, R > 2 years), intermediate recurrence (IR, n = 22, 1 year < R < or = 2 years), and early recurrence (ER, n = 21, R < or = 1 year).
The overall 5-year survival rate for patients with p-stage I was 79.9 %. The overall 5-year survival rates were 91.0 %, 55.6 %, 17.1 %, and 7.5 % for the NR, LR, IR, and ER group, respectively. Preoperative high CEA level, lymphatic permeation, and pleural invasion were proven to be independent factors for overall recurrence. Moreover, multivariate analysis showed that preoperative CEA level, pathological T factor, lymphatic permeation, vascular invasion, and pleural invasion influenced early recurrence within one year.
The present study demonstrated that preoperative CEA level, pathological T-factor, lymphatic permeation, vascular invasion, and pleural invasion were independent prognostic factors for early recurrence within one year, even in patients with pathological stage I. In patients with these factors, adjuvant therapy may be indicated since this may improve their survival.