Long-term survival outcome after postoperative recurrence of non-small-cell lung cancer: who is 'cured' from postoperative recurrence?

Keigo Sekihara, Tomoyuki Hishida, Junji Yoshida, Tomonari Oki, Tomokazu Omori, Shinya Katsumata, Takuya Ueda, Tomohiro Miyoshi, Masaki Goto, Syoko Nakasone, Tomohiro Ichikawa, Reiko Matsuzawa, Keiju Aokage, Koichi Goto, Masahiro Tsuboi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVES: Since survival after postoperative non-small-cell lung cancer (NSCLC) recurrence is extremely poor, the long-term post-recurrence outcomes are not well understood. The purpose of this study was to evaluate the long-term post-recurrence outcomes and clarify who are possibly 'cured' in recent clinical practice.

METHODS: We reviewed the medical records of 635 patients who developed postoperative recurrence until 2012 after R0 resection for pathological Stage IA-IIIA NSCLC between 1993 and 2006. Factors associated with post-recurrence survival (PRS) and the characteristics of the long-term (≥5 years) survivors were analysed retrospectively.

RESULTS: The 5-year PRS rate of all 635 patients was 13%. Multivariable analysis revealed that female [hazard ratio (HR) = 0.78], adenocarcinoma (HR = 0.77), locoregional (only) recurrence (HR = 0.59) and longer recurrence-free survival (HR = 0.99) were favourably associated with PRS. A total of 51 patients achieved 5-year PRS; however, 32 (63%) were cancer-bearing patients in their fifth post-recurrent year who were mainly treated by epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). Subsequent PRS curves for cancer-controlled and cancer-bearing groups were different (8-year PRS: 94% vs 31%, P = 0.003). Among 19 cancer-controlled patients in their fifth post-recurrent year, 17 (89%) patients initially received radical local therapy for their recurrence.

CONCLUSIONS: Two-thirds of 5-year survivors after postoperative NSCLC recurrence had a cancer-bearing status and showed deteriorated subsequent survival. Curability of postoperative NSCLC recurrence should be evaluated in terms of the 'cancer-controlled' status, and 'cured' population is included in the patients who are 'cancer controlled' at the fifth post-recurrent year.

Original languageEnglish
Pages (from-to)522-528
Number of pages7
JournalEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume52
Issue number3
DOIs
Publication statusPublished - 2017 Sep 1
Externally publishedYes

Keywords

  • Cancer bearing
  • Cancer controlled
  • EGFR-TKI
  • Non-small-cell lung cancer
  • Post-recurrence survival
  • Postoperative recurrence
  • Prognostic factors

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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