Tumor Recurrence After Complete Resection for Non-Small Cell Lung Cancer

Background. Long-term survival after R0 resection for non-small cell lung cancer (NSCLC) is less than 50%. The majority of mortality after resection is related to tumor recurrence. The purpose of this study was to identify independent perioperative and pathologic variables that are associated with NSCLC recurrence after complete surgical resection. Methods. A retrospective examination was performed of a prospectively maintained database of patients who underwent resection for NSCLC from July 1999 to August 2008 at a single institution. Clinicopathologic variables were evaluated for their influence on time to recurrence. Cox's proportional regression hazard model examined the association of recurrence in NSCLC. Results. A total of 1,143 patients met inclusion criteria and had complete follow-up information. Of these patients, 378 (33.1%) had recurrence of the primary cancer. Median follow-up was 24 months (range, 3-134 months). Preoperative tumor maximum standardized uptake value (SUVmax) greater than 5 was associated with increased risk of recurrence (hazard ratio [HR], 1.81; p = 0.01). Preoperative radiation was independently associated with recurrence (HR, 1.98; p = 0.05) as well as the presence of pathologic stage II and stage III disease (stage II: HR, 2.53; p = 0.05; stage III: HR, 6.49; p = 0.006). Subgroup analysis found that sublobar resection was also associated with locoregional recurrence after resection (HR, 4.17; p = 0.02) and lymphovascular invasion of distant recurrence (HR, 4.21; p = 0.002). Conclusions. In the largest series reported to date on postresectional recurrence of NSCLC, SUVmax greater than 5, increasing pathologic stage, and the administration of preoperative radiation were independently associated with NSCLC recurrence after resection. Sublobar resection was independently associated with locoregional recurrence, and lymphovascular invasion was associated with distant recurrence. (Ann Thorac Surg 2012;93:1813-21) (c) 2012 by The Society of Thoracic Surgeons