Recurrence Risk Factors Analysis for Stage I Non-small Cell Lung Cancer

Abstract

Lung cancer is the leading cause of cancer-related death worldwide. Even early-stage patients might encounter disease recurrence with relative high risk. Effective postoperative therapy is based on an accurate assessment of treatment failure after surgery. The aim of this study is to construct a disease-free survival (DFS) prediction model and stratify patients into different risk score groups.A total of 356 pathological stage I patients (7th American Joint Committee on Cancer) who underwent lung resection from January 2005 through June 2011 were retrospectively reviewed. Of these patients, 63 patients were eliminated for this study. A total of 293 p-stage I patients were included for further univariate and multivariate analysis. Clinical, surgical, and pathological factors associated with high risk of recurrence were analyzed, including age, gender, smoking status, additional primary malignancy (APM), operation method, histology, visceral pleural invasion, angiolymphatic invasion, tumor necrosis, and tumor size.Of the 293 p-stage I non-small cell lung cancer (NSCLC) patients examined, 143 were female and 150 were male, with a mean age of 62.8-years old (range: 25–83-years old). The 5-year DFS and overall survival rates after surgery were 58.9% and 75.3%, respectively. On multivariate analysis, current smoker (hazards ratio [HR]: 1.63), APM (HR: 1.86), tumor size (HR: 1.54, 2.03), nonanatomic resections (HR: 1.81), adenocarcinoma histology (HR: 2.07), visceral pleural invasion (HR: 1.54), and angiolymphatic invasion (HR: 1.53) were found to be associated with a higher risk of tumor recurrence. The final model showed a fair discrimination ability (C-statistic = 0.68). According to the difference risk group, we found patients with intermediate or higher risk group had a higher distal relapse tendency as compared with low risk group (P = 0.016, odds ratio: 3.31, 95% confidence interval: 1.21–9.03).Greater than 30% of disease recurrences occurred after surgery for stage I NSCLC patients. That is why we try to establish an effective DFS predicting model based on clinical, pathological, and surgical covariates. However, our initial results still need to be validated and refined into greater population for better application in clinical use.

Evaluation of Prognostic Factors for Survival in Stage I Non-small Cell Lung Carcinoma

“…When the effect of age on survival rate was examined, patients aged <65 years had high survival rates (7)(8)(9). When based on different age groups, some studies reported no statistically significant differences, whereas others showed significant differences between survival and age (10)(11)(12)(13)(14)(15)(16). In this study, no statistically significant effect was detected between patients aged <65 years and those aged >65 years when compared in terms of their survival rates (p=0.885).…”

“…It was reported that stage 1a and T1aN0M0 patients had statistically significant differences when compared with other stages in terms of tumor recurrence (17). In another study, T1aN0M0 patients demonstrated statistically significant differences in survival rates compared with patients at other stages (including T1bN0M0) (14). There are also some publications reporting no statistically significant differences between T1aN0M0 and T1bN0M0 in terms of survival rates (7).…”

“…In multivariate analysis, there were no significant differences among the histologic types. However, numerous studies have indicated that there is no statistically significant relationship between survival and histopathologic type (7)(8)(9)(10)14). Generally, study groups on thoracic oncology consider adenocarcinomas to have worse prognosis than epidermoid carcinomas.…”

“…In a multicenter study with 12.349 patients who underwent surgery with a diagnosis of early-stage NSCLC, it was reported that lobectomy had higher survival rates than other types of lung resections (25). In a study on 293 patients with stage 1 NSCLC, the risk of recurrence was investigated, and the results showed that patients who underwent anatomic resection had higher survival rates than those who underwent wedge resections (14). A study on recurrence rates of surgically treated stage 1a NSCLC patients found that there was no statistically significant difference in terms of survival between patients who underwent lobectomy and those who underwent bilobectomy or pneumonectomy (p=0.946) (11).…”

Potential use of microRNA-200c as a prognostic marker in non-small cell lung cancer

“…Between 40 and 50% of patients will eventually succumb to relapse or metastatic disease after curative resection (3). However, few reliable prognostic biomarkers are available in clinical practice, particularly in patients who have undergone curative surgical resection (4). Therefore, there is a requirement to identify novel prognostic biomarkers that could aid prognosis prediction and optimize the treatment of NSCLC patients.…”