Predictors of early recurrence for node-negative t1 to T2B non-small cell lung cancer

Background. Recurrence develops in nearly one-thirdof patients who undergo complete resection for nonsmallcell lung cancer (NSCLC). We sought to identifypredictors of early recurrence (<2 years) in node-negativeT1 to T2b NSCLC.

Methods. We used a 10-year (1999 to 2008) singleinstitutionretrospective review of a prospectively maintainedlung cancer database. Exclusion criteria includedcarcinoid, adenocarcinoma in situ, and minimally invasiveadenocarcinoma histologies, and any inductiontherapy. Patient demographics, clinical, and pathologicvariables were analyzed. Recurrence was confirmed histologicallyin 86 patients (85%) or radiographically in16 (15%). Univariable and multivariable logistic regression(C statistic [ 0.7) and Cox proportional hazardsanalyses were performed (p lt; 0.05 is significant).

Results. An R0 resection of a node-negative T1 to T2bNSCLCwas performedin 532 patients.Procedures includedlobectomy in 436, segmentectomy in 47, and wedgeresection in 49.Recurrencewas present in 102 patients (19%)and was locoregional in 33 (32%), distant in 40 (39%), andmultisite in 29 (29%). T size, tumor histology, tumor grade,smoking status, maximum standardized uptake value, andalbuminwere not associatedwith recurrence.Multivariablepredictors of recurrence were lymphovascular invasion(odds ratio, 2.48), sublobar resection (odds ratio, 2.37), andage (odds ratio, 0.96). Recurrence was independently associatedwith lung cancer-specific death (relative risk, 11.78;95% confidence interval, 5.46 to 25.36; p < 0.001) and overallmortality (relative risk, 1.27; 95%confidence interval, 1.16 to1.39, p < 0.001).

Conclusions. We demonstrate a 19% early recurrencerate in R0 resected node-negative T1 to T2b NSCLC. Theidentification of unique predictors of recurrence is animportant step toward defining a patient population thatmay benefit from adjuvant therapy.