TY - JOUR
T1 - Long-term survival outcome after postoperative recurrence of nonsmall- cell lung cancer
T2 - who is 'cured' from postoperative recurrence?
AU - Sekihara, Keigo
AU - Hishida, Tomoyuki
AU - Yoshida, Junji
AU - Oki, Tomonari
AU - Omori, Tomokazu
AU - Katsumata, Shinya
AU - Ueda, Takuya
AU - Miyoshi, Tomohiro
AU - Goto, Masaki
AU - Nakasone, Syoko
AU - Ichikawa, Tomohiro
AU - Matsuzawa, Reiko
AU - Aokage, Keiju
AU - Goto, Koichi
AU - Tsuboi, Masahiro
N1 - Funding Information:
The work was supported in part by an Grant-in-Aid for Cancer Research from Japan Society for the Promotion of Science.
Publisher Copyright:
© The Author 2017.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - OBJECTIVES: Since survival after postoperative non-small-cell lung cancer (NSCLC) recurrence is extremely poor, the long-term postrecurrence 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 cancercontrolled 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.
AB - OBJECTIVES: Since survival after postoperative non-small-cell lung cancer (NSCLC) recurrence is extremely poor, the long-term postrecurrence 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 cancercontrolled 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.
KW - Cancer bearing
KW - Cancer controlled
KW - EGFR-TKI
KW - Non-small-cell lung cancer
KW - Post-recurrence survival
KW - Postoperative recurrence
KW - Prognostic factors
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U2 - 10.1093/ejcts/ezx127
DO - 10.1093/ejcts/ezx127
M3 - Article
C2 - 28482033
AN - SCOPUS:85041861946
VL - 52
SP - 522
EP - 528
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 3
ER -