Prognostic factors of tumor recurrence in completely resected non-small cell lung cancer

Abstract

BackgroundPatients with completely resected non-small cell lung cancer (NSCLC) have an excellent outcome; however tumor recurs in 30%–77% of patients. This study retrospectively analyzed the clinicopathologic features of patients with any operable stage of NSCLC to identify the prognostic factors that influence tumor recurrence, including intratumoral blood vessel invasion (IVI), tumor size, tumor necrosis, and intratumoral lymphatic invasion.MethodsFrom January 2002 to December 2011, 227 consecutive patients were enrolled in this study. They were divided into two groups: the “no recurrence” group and the “recurrence” group. Recurrence-free survival was analyzed by multivariable Cox regression analysis, stratified by tumor staging, chemotherapy, and nodal involvement.ResultsIVI, tumor necrosis, tumor diameter more than 5 cm, and nodal involvement were identified as independent prognostic factors of tumor recurrence. The hazard ratio (HR) of patients with IVI was 2.1 times higher than that of patients without IVI (95% confident interval [CI]: 1.4–3.2) (P = 0.001).The HR of patients with tumor necrosis was 2.1 times higher than that of patients without tumor necrosis (95% CI: 1.3–3.4) (P = 0.001). Patients who had a maximum tumor diameter greater than 5 cm had significantly higher risk of recurrence than patients who had a maximum tumor diameter of less than 5 cm (HR 1.9, 95% CI: 1.0–3.5) (P = 0.033).ConclusionIVI, tumor diameter more than 5 cm, and tumor necrosis are prognostic factors of tumor recurrence in completely resected NSCLC. Therefore, NSCLC patients, with or without nodal involvement, who have one or more prognostic factors of tumor recurrence may benefit from adjuvant chemotherapy for prevention of tumor recurrence.

Evaluation of lung cancer by enhanced dual-energy CT: association between three-dimensional iodine concentration and tumour differentiation

“…9 Therefore, higher-grade (G3 and G4) lung cancers tend to have lower iodine volumes on contrast-enhanced CT. Since tumour necrosis and DTD are independent and significant prognostic factors in non-small-cell lung carcinoma, [21][22][23] iodine volume might be associated with prognosis. The enhancement of lung adenocarcinoma is also modified by intratumoral fibrosis, which is correlated with invasiveness and prognosis, and tumours with abundant internal fibrosis tend to show weak enhancement.…”

Time-Varying Pattern of Postoperative Recurrence Risk of Early-Stage (T1a-T2bN0M0) Non-Small Cell Lung Cancer (NSCLC): Results of a Single-Center Study of 994 Chinese Patients

“…In most studies, the risk of recurrence is analyzed using survival curves rather than hazard functions [5] , [6] . The hazard function, which depicts the rate of recurrence at any point in time among the remaining at-risk individuals, has been applied to provide insights into the patterns of recurrence of breast cancer [7] , [8] and gastric cancer [9] .…”

Necrosis and apoptotic index as prognostic factors in non-small cell lung carcinoma: a review

“…Thus, in the last decades, the prognostic significance of necrosis in resectable non-small cell carcinomas has been assessed by many investigators in a series of, mostly retrospective, studies investigating the impact of these histological features on survival of patients. (Lipford et al 1984 ; Elson et al 1988 ; Lee et al 1989 ; Roeslin et al 1991 ; Roberts et al 1992 ; Shahab et al 1992 ; Tormanen et al 1995 ; Kessler et al 1996 ; Goldstein et al 1999 ; Swinson et al 2002 ; Poleri et al 2003 ; Khan et al 2004 ; Rena et al 2007 ; Inoue et al 2008 ; Cho et al 2008 ; Sardari Nia et al 2010 ; Kiliçgün et al 2010 ; Park et al 2011 ; Pataer et al 2012 ; Tantraworasin et al 2013 ).…”

“…In the majority of these previous studies, clinical, pathological and follow up data were correlated to tumor necrosis. In 7 studies (Elson et al 1988 ; Shahab et al 1992 ; Goldstein et al 1999 ; Poleri et al 2003 ; Rena et al 2007 ; Cho et al 2008 ; Tantraworasin et al 2013 ), patients of stages II and III were excluded, while patients of clinical stage III were the target group in a single report (Lee et al 1989 ) and clinical stage was not included in the statistical evaluation of one paper (Roberts et al 1992 ). In the remaining studies (Lipford et al 1984 ; Roeslin et al 1991 ; Tormanen et al 1995 ; Kessler et al 1996 ; Swinson et al 2002 ; Khan et al 2004 ; Inoue et al 2008 ; Sardari Nia et al 2010 ; Kiliçgün et al 2010 ; Park et al 2011 ; Pataer et al 2012 ) patients of various clinical stages (I, II, III) were included.…”

“…The aim of this study was to perform a review of the MEDLINE literature in an attempt to determine the exact clinical value of tumor necrosis and apoptotic index (AI) as prognostic biomarkers in NSCLC. We retrieved 28 papers, investigating the prognostic significance of necrosis and/or apoptosis in patients with primary NSCLC (Tables 1 and 2 ) (Lipford et al 1984 ; Elson et al 1988 ; Lee et al 1989 ; Roeslin et al 1991 ; Roberts et al 1992 ; Shahab et al 1992 ; Tormanen et al 1995 ; Kessler et al 1996 ; Goldstein et al 1999 ; Swinson et al 2002 ; Poleri et al 2003 ; Khan et al 2004 ; Rena et al 2007 ; Inoue et al 2008 ; Cho et al 2008 ; Sardari Nia et al 2010 ; Kiliçgün et al 2010 ; Park et al 2011 ; Pataer et al 2012 ; Tantraworasin et al 2013 ; Komaki et al 1996 ; Tanaka et al 1999 ; Matturi et al 1999 ; Langendijk et al 2000 ; Gorgoulis et al 2000 ; Hwang et al 2001 ; Puglisi et al 2002 ; Dworakowska et al 2009 ). Studies on apoptosis-related genes were excluded.…”