Factors influencing recurrence following curative surgical treatment for pathologic stage 1A non-small cell lung cancer
Yoohwa Hwang, Beatrice Chia-Hui Shih, Jae Hyun Jeon, Sukki Cho, Kwhanmien Kim, Sanghoon Jheon.
Seoul National University Bundang Hospital, Seongnamsi, Korea, Republic of.
OBJECTIVE:This study aimed to elucidate recurrence patterns and to identify predictors of time to recurrence after intensive curative surgical treatment for pathologic Stage IA non-small cell lung cancer (NSCLC).
METHODS:A total of 1509 patients who underwent surgical resection for pathologic IA NSCLC between 2003 and 2017 were retrospectively analyzed. The recurrence was recorded as locoregional (involving the same lobe, mediastinal or hilar lymph nodes or a ipsilateral difference lobe) or distant (including distant metastasis and pleural disease). Freedom free recurrence rate was estimated using the Kaplan-Meier method, and recurrence risk factors were identified by univariate and multivariate analysis.
RESULTS:A total of 121 recurrences (8.0%) were recorded at a median follow-up of 61.9 months (range 3-200 month). The median time to recurrence was 25.1month. The 5-year recurrence free rate for pathologic T1aN0M0, T1bN0M0, and T1cN0M0 were 97.1%, 92.6%, and 87.1%, respectively. Recurrence patterns were locoregional metastasis (58.7%) and distant metastasis (41.3%) Multivariable analysis revealed that invasive component size of tumor (HR 2.49, 95% CI 1.46-4.24), vascular invasion (HR 5.02, 95% CI 2.39-10.53), and STAS (HR 2.38, 95% CI 1.23-4.59) were independent predictors of recurrence risk. In subgroup analysis, sublobar resection were associated with a higher risk of recurrence among pT1bN0M0 and pT1cN0M0. (HR 2.8, 95% CI 1.91-4.18)
CONCLUSIONS:Recurrence following curative surgical resection for pathologic stage IA NSCLC is influenced predominantly pathologic invasive tumor size, vascular invasion, and STAS. Patients with an invasive component tumor size greater than 1cm appear to be at high risk of recurrence after sublobar resection.
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