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Local recurrence after surgery for early stage lung cancer†

An 11-year experience with 975 patients

  1. Chris R. Kelsey MD1,‡,*,
  2. Lawrence B. Marks MD2,
  3. Donna Hollis MS3,
  4. Jessica L. Hubbs MS2,
  5. Neal E. Ready MD, PhD4,
  6. Thomas A. D'Amico MD5,
  7. Jessamy A. Boyd MD1

Article first published online: 11 AUG 2009

DOI: 10.1002/cncr.24625

Issue

Cancer

Cancer

Volume 115, Issue 22, pages 5218–5227, 15 November 2009

Additional Information

How to Cite

Kelsey, C. R., Marks, L. B., Hollis, D., Hubbs, J. L., Ready, N. E., D'Amico, T. A. and Boyd, J. A. (2009), Local recurrence after surgery for early stage lung cancer. Cancer, 115: 5218–5227. doi: 10.1002/cncr.24625

Author Information

  1. 1

    Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina

  2. 2

    Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina

  3. 3

    Duke Cancer Center Biostatistics, Duke University Medical Center, Durham, North Carolina

  4. 4

    Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina

  5. 5

    Department of Surgery, Duke University Medical Center, Durham, North Carolina

  1. ‡

    Fax: (919) 668-7345

*Department of Radiation Oncology, Duke University Medical Center 3085, Durham, NC 27710

  1. †

    Presented in part at the 44th Annual Meeting of the American Society of Clinical Oncology, Chicago, Illinois, May 30-June 3, 2008; and the 50th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Boston, Massachusetts, September 21-25, 2008.

Publication History

  1. Issue published online: 3 NOV 2009
  2. Article first published online: 11 AUG 2009
  3. Manuscript Accepted: 15 MAY 2009
  4. Manuscript Revised: 14 MAY 2009
  5. Manuscript Received: 1 DEC 2008

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Keywords:

  • nonsmall cell lung cancer;
  • local recurrence;
  • local/regional recurrence;
  • patterns of failure;
  • radiotherapy

Abstract

BACKGROUND:

The objective of the current study was to evaluate the actuarial risk of local failure (LF) after surgery for stage I to II nonsmall cell lung cancer (NSCLC) and assess surgical and pathologic factors affecting this risk.

METHODS:

The records, including pertinent radiologic studies, of all patients who underwent surgery for T1 to T2, N0 to N1 NSCLC at Duke University between 1995 and 2005 were reviewed. Risks of disease recurrence were estimated using the Kaplan-Meier method. A multivariate Cox regression analysis assessed factors associated with LF in the entire cohort and a subgroup undergoing optimal surgery for stage IB to II disease.

RESULTS:

For all 975 consecutive patients, the 5-year actuarial risk of local and/or distant disease recurrence was 36%. First sites of failure were local only (25%), local and distant (29%), and distant only (46%). The 5-year actuarial risk of LF was 23%. On multivariate analysis, squamous/large cell histology (hazards ratio [HR], 1.98), stage > IA (HR, 2.02), and sublobar resections (HR, 1.99) were found to be independently associated with a higher risk of LF. For the subset of patients (n = 445) undergoing at least a lobectomy with negative surgical margins and currently considered for adjuvant chemotherapy (stage IB-II disease), the 5-year actuarial risk of LF was 27%. Within this subgroup, squamous/large cell histology (HR, 2.5) and lymphovascular space invasion (HR, 1.74) were associated with a higher risk of LF. The 5-year rate of LF was 13%, 32%, and 47%, respectively, with 0, 1, or 2 risk factors.

CONCLUSIONS:

Greater than half of disease recurrences after surgery for early stage NSCLC involved local sites. Pathologic factors may help to distinguish those patients at highest risk. Cancer 2009. © 2009 American Cancer Society.

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