BACKGROUND:: This study assessed the impact of
surgical,
histopathologic and patient-related factors on the risks of local and distant recurrence and overall survival for patients with stages I through IIIA nonsmall cell
lung carcinoma (
NSCLC) undergoing definitive resection with or without
adjuvant chemotherapy. METHODS:: This study included 373 consecutive patients treated between 2000 and 2005 who did not receive adjuvant or
neoadjuvant radiotherapy, had at least 3 months of follow-up, and did not have a history of other cancers within 5 years of the diagnosis of their
NSCLC. Of these, 52% had pathologic stage IA disease, 30% had stage IB, 5% had stage IIA, 8% had stage IIB and 5% had stage III disease. Forty-four patients received
chemotherapy. RESULTS:: The
median follow-up was 33 months. Local
failure rates at 2 years, 3 years, and 5 years were 16%, 22%, and 32%, respectively; distant recurrence rates were 13%, 15%, and 21%, respectively.
Multivariable analysis revealed that local recurrence was significantly associated with the presence of
lymphatic or vascular invasion (LVI), the use of
chemotherapy, and having
diabetes; distant recurrence was significantly higher in patients with nonsquamous cell
histology, those undergoing
pneumonectomy, and those with more advanced
TNM stage. Survival was significantly associated with age, history of
myocardial infarction, performance of a
pneumonectomy,
histology, LVI, and the number of positive N1
lymph nodes. CONCLUSIONS:: Local recurrence was the predominant type of failure in this series. Patient with
diabetes or LVI may benefit from close
surveillance and aggressive therapy of
asymptomatic local recurrences, especially when
chemotherapy is given in addition to
surgery. Cancer 2009. (c) 2009 American Cancer Society.
