Predictors of early recurrence for node-negative t1 to t2b non-small cell lung cancer

Background: Recurrence develops in nearly one-third of patients who undergo complete resection for non-small cell lung cancer (NSCLC). We sought to identify predictors of early recurrence (<2 years) in node-negative T1 to T2b NSCLC.

Methods: We used a 10-year (1999 to 2008) single-institution retrospective review of a prospectively maintained lung cancer database. Exclusion criteria included carcinoid, adenocarcinoma in situ, and minimally invasive adenocarcinoma histologies, and any induction therapy. Patient demographics, clinical, and pathologic variables were analyzed. Recurrence was confirmed histologically in 86 patients (85%) or radiographically in 16 (15%). Univariable and multivariable logistic regression (C statistic = 0.7) and Cox proportional hazards analyses were performed (p < 0.05 is significant).

Results: An R0 resection of a node-negative T1 to T2b NSCLC was performed in 532 patients. Procedures included lobectomy in 436, segmentectomy in 47, and wedge resection in 49. Recurrence was present in 102 patients (19%) and was locoregional in 33 (32%), distant in 40 (39%), and multisite in 29 (29%). T size, tumor histology, tumor grade, smoking status, maximum standardized uptake value, and albumin were not associated with recurrence. Multivariable predictors of recurrence were lymphovascular invasion (odds ratio, 2.48), sublobar resection (odds ratio, 2.37), and age (odds ratio, 0.96). Recurrence was independently associated with lung cancer-specific death (relative risk, 11.78; 95% confidence interval, 5.46 to 25.36; p < 0.001) and overall mortality (relative risk, 1.27; 95% confidence interval, 1.16 to 1.39, p < 0.001).

Conclusions: We demonstrate a 19% early recurrence rate in R0 resected node-negative T1 to T2b NSCLC. The identification of unique predictors of recurrence is an important step toward defining a patient population that may benefit from adjuvant therapy.