Predictors of distant, local and lymph node recurrence for surgically treated non-small cell lung cancer (NSCLC) patients: Retrospective analysis of pathological T1–4, N0, R0, M0 tumor stages

Abstract

Background

Lung cancer has a high recurrence rate after successful surgical treatment. This study deals with possible risk factors and recommendations to improve the treatment of non-small cell lung cancer (NSCLC).

Methods

In this retrospective analysis, we used data of all NSCLC patients who underwent lobectomy at the Lung Cancer Center Munich between 2011 and 2020. Only patients with postoperative T1–4, N0, R0, M0 were included. We compared numerical outcomes between patients with distant, lymph node, local recurrence and no recurrence using analysis of variance (ANOVA), and categorical outcomes using Chi-squared test or Fisher’s exact test when cell numbers were <6. We used logistic regression models to identify factors significantly associated with the occurrence of a distant, lymph node and local recurrence.

Results

Tumor size in cm was significantly higher in patients with local recurrence (mean 5.5) followed by distant recurrence (mean 4.0), lymph node recurrence (mean 3.1) and patients with no recurrence (mean 3.0), p<0.0001. Diffusing capacity for carbon monoxide (DLCO) in % was significantly higher in patients with no recurrence (72.9) and decreased with distant recurrence (67.0), local recurrence (66.7) and lymph node recurrence (65.8), p=0.01. There were no significant differences in postoperative complications, surgical approach or number of lymph node assessed. A tumor size ≥4.65 cm was identified as an independent marker for local recurrence.

Conclusion

For patients with NSCLC ≥4.65 cm, which corresponds to UICC stage IIA and higher, multimodal therapy should be discussed. The surgical approach has no influence on recurrence.

Zusammenfassung

Hintergrund

Lungenkrebs weist nach erfolgreicher chirurgischer Behandlung eine hohe Rezidivrate auf. Diese Studie befasst sich mit möglichen Risikofaktoren und Empfehlungen zur Verbesserung der Behandlung des nicht-kleinzelligen Lungenkarzinoms (NSCLC).

Methoden

In dieser retrospektiven Analyse wurden die Daten aller NSCLC-Patienten verwendet, die sich zwischen 2011 und 2020 einer Lobektomie am Lungenkrebszentrum München unterzogen. Es wurden nur Patienten mit postoperativem T1–4, N0, R0, M0 eingeschlossen. Wir verglichen numerische Ergebnisse zwischen Patienten mit Fernmetastasen, Lymphknotenrezidiven, Lokalrezidiven und rezidivfreien Patienten mithilfe der Varianzanalyse (ANOVA) und kategorische Ergebnisse mithilfe des Chi2-Tests oder des exakten Fischertests, wenn die Zellzahlen <6 waren. Mit logistischen Regressionsmodellen wurden Faktoren ermittelt, die signifikant mit dem Auftreten von Fernmetastasen, Lymphknotenrezidiven oder Lokalrezidiven verbunden sind.

Ergebnisse

Die Tumorgröße in cm war signifikant höher bei Patienten mit Lokalrezidiv (Mittelwert 5,5), gefolgt von Fernmetastasen (Mittelwert 4,0), Lymphknotenrezidiv (Mittelwert 3,1) und rezidivfreie Patienten (Mittelwert 3,0), p<0,0001. Die Diffusionskapazität für Kohlenmonoxid (DLCO) in % war bei Patienten ohne Rezidiv signifikant höher (72,9) und nahm bei Patienten mit Fernmetastasierung (67,0), Lokalrezidiv (66,7) und Lymphknotenrezidiv (65,8) ab, p=0,01. Es gab keine signifikanten Unterschiede bei den postoperativen Komplikationen, dem chirurgischen Zugang oder der Anzahl an untersuchten Lymphknoten. Eine Tumorgröße ≥4,65 cm wurde als unabhängiger Faktor für ein Lokalrezidiv identifiziert.

Schlussfolgerung

Bei Patienten mit NSCLC ≥4,65 cm, was dem UICC-Stadium IIA und höher entspricht, sollte eine multimodale Therapie diskutiert werden. Der chirurgische Zugang hat keinen Einfluss auf das Rezidiv.

Keywords

non-small cell lung cancer - postoperative recurrence - risk factors - tumor size - diffusing capacity for carbon monoxide

Schlüsselwörter

nicht-kleinzelliges Lungenkarzinom - postoperatives Rezidiv - Risikofaktoren - Tumorgröße - Diffusionskapazität für Kohlenmonoxid

Publication History

Received: 21 May 2025

Accepted after revision: 04 December 2025

Article published online:
22 January 2026

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