Early Recurrence after Surgical Resection in Patients with Pathological Stage I Non-small Cell Lung Cancer

Abstract

Introduction: Early recurrence is observed even in patients who undergo complete resection and had pathological (p-) stage I. Therefore, we focused on early recurrence, and attempted to elucidate the relationship between early recurrence and clinicopathological factors. Methods: Between May 1993 and December 2005, 1201 patients with non-small cell lung cancer (NSCLC) underwent surgical treatment at our institution. Of these, 402 patients who underwent complete resection and had p-stage I NSCLC were retrospectively analyzed for clinicopathological factors. Patients were divided into four groups according to the period between surgery and recurrence (R): no recurrence (NR, n = 331), late recurrence (LR, n = 28, R > 2 years), intermediate recurrence (IR, n = 22, 1 year < R ≤ 2 years), and early recurrence (ER, n = 21, R ≤ 1 year). Results: The overall 5-year survival rate for patients with p-stage I was 79.9 %. The overall 5-year survival rates were 91.0 %, 55.6 %, 17.1 %, and 7.5 % for the NR, LR, IR, and ER group, respectively. Preoperative high CEA level, lymphatic permeation, and pleural invasion were proven to be independent factors for overall recurrence. Moreover, multivariate analysis showed that preoperative CEA level, pathological T factor, lymphatic permeation, vascular invasion, and pleural invasion influenced early recurrence within one year. Conclusions: The present study demonstrated that preoperative CEA level, pathological T-factor, lymphatic permeation, vascular invasion, and pleural invasion were independent prognostic factors for early recurrence within one year, even in patients with pathological stage I. In patients with these factors, adjuvant therapy may be indicated since this may improve their survival.

Key words

thoracic surgery - lung cancer - carcinoembryonic antigen - recurrence - adjuvant therapy - survival

References

• 1 Martini N, Bains M S, Burt M E, Zakowski M F, McCormack P, Rusch V W, Ginsberg R J. Incidence of local recurrence and second primary tumors in resected stage I lung cancer.  J Thorac Cardiovasc Surg. 1995;  109 (1) 120-129
• 2 Harpole Jr D H, Herndon 2nd J E, Young Jr W G, Wolfe W G, Sabiston Jr D C. Stage I nonsmall cell lung cancer. A multivariate analysis of treatment methods and patterns of recurrence.  Cancer. 1995;  76 (5) 787-796
• 3 Douillard J Y, Rosell R, De Lena M, Carpagnano F, Ramlau R, Gonzáles-Larriba J L, Grodzki T, Pereira J R, Le Groumellec A, Lorusso V, Clary C, Torres A J, Dahabreh J, Souquet P J, Astudillo J, Fournel P, Artal-Cortes A, Jassem J, Koubkova L, His P, Riggi M, Hurteloup P. ANITA adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial.  Lancet Oncol. 2006;  7 (9) 719-727
• 4 Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon J P, Vansteenkiste J. International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer.  N Engl J Med. 2004;  350 (4) 351-360
• 5 Kato H, Ichinose Y, Ohta M, Hata E, Tsubota N, Tada H, Watanabe Y, Wada H, Tsuboi M, Hamajima N, Ohta M. Japan Lung Cancer Research Group on Postsurgical Adjuvant Chemotherapy. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung.  N Engl J Med. 2004;  350 (17) 1713-1721
• 6 International Union Against Cancer .Lung tumours. Sobin LH, Wittekind CH TNM classification of malignant tumours. 6th ed. New York; Wiley-Liss 2002
• 7 Travis W D, Colby T V, Corrin B et al. Histological typing of lung and pleural tumors; World Health Organization international histological classification of tumors. Berlin; Springer 1999
• 8 Rubins J B, Dunitz J, Rubins H B, Maddaus M A, Niewoehner D E. Serum carcinoembryonic antigen as an adjunct to preoperative staging of lung cancer.  J Thorac Cardiovasc Surg. 1998;  116 (3) 412-416
• 9 Sawabata N, Ohta M, Takeda S, Hirano H, Okumura Y, Asada H, Maeda H. Serum carcinoembryonic antigen level in surgically resected clinical stage I patients with non-small cell lung cancer.  Ann Thorac Surg. 2002;  74 (1) 174-179
• 10 Buccheri G, Ferrigno D. Identifying patients at risk of early postoperative recurrence of lung cancer: a new use of the old CEA test.  Ann Thorac Surg. 2003;  75 (3) 973-980
• 11 Takamochi K, Yoshida J, Nishimura M, Yokose T, Sasaki S, Nishiwaki Y, Suzuki K, Nagai K. Prognosis and histologic features of small pulmonary adenocarcinoma based on serum carcinoembryonic antigen level and computed tomographic findings.  Eur J Cardiothorac Surg. 2004;  25 (5) 877-883
• 12 Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A, Tsubota N. Effect of histologic type and smoking status on interpretation of serum carcinoembryonic antigen value in non-small cell lung carcinoma.  Ann Thorac Surg. 2004;  78 (3) 1004-1009
• 13 Pretreatment evaluation of non-small-cell lung cancer. The American Thoracic Society and The European Respiratory Society.  Am J Respir Crit Care Med. 1997;  156 (1) 320-332
• 14 Depierre A, Lagrange J L, Theobald S, Astoul P, Baldeyrou P, Bardet E, Bazelly B, Bréchot J M, Breton J L, Douillard J Y, Grivaux M, Jacoulet P, Khalil A, Lemarié E, Martinet Y, Massard G, Milleron B, Molina T, Moro-Sibilot D, Paesmans M, Pujol J L, Quoix E, Ranfaing E, Rivière A, Sancho-Garnier H, Souquet P J, Spaeth D, Stoebner-Delbarre A, Thiberville L, Touboul E, Vaylet F, Vergnon J M, Westeel V. FNCLCC . Summary report of the standards, options and recommendations for the management of patients with non-small-cell lung carcinoma (2000).  Br J Cancer. 2003;  89 (Suppl. 1) S35-S49
• 15 Silvestri G A, Gould M K, Margolis M L, Tanoue L T, McCrory D, Toloza E, Detterbeck F. American College of Chest Physicians. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition).  Chest. 2007;  132 (Suppl. 3) 178S-201S