Background: Currently, there is no consensus on the follow-up strategy (follow-up time interval and content) of non-small cell lung cancer (NSCLC) in the world, and the relevant clinical evidence is also very limited. In this study, we aimed to summarize the recurrence/metastasis sites and timings of stage I NSCLC patients based on their follow-up data, aiming to provide a basis of follow-up time interval and content for this group of patients.
Methods: We retrospectively analyzed the 416 stage I NSCLC patients that underwent continuous anatomic lobectomy between Jan. 2000 to Oct. 2013 in our prospective lung cancer database. According to the recurrence/metastasis sites and timings, the long term follow-up time interval and content were explored.
Results: The 5-yr disease free survival (DFS) and overall survival (OS) in the whole group were 82.4% and 85.4%, respectively. There were 76 cases (18.3%) had recurrence/metastasis during follow-up, among which the most frequent site was pulmonary metastasis (21 cases, 5.0%), followed by brain metastasis (20 cases, 4.8%), bone metastasis (12 cases, 2.9%), and mediastinal lymph node metastasis (12 cases, 2.9%). Among the factors that could influence recurrence/metastasis, patients with pT2a suffered from a higher recurrence/metastasis rate compared to patients with pT1 (P=0.006), with 5-yr DFS being 73.8% and 87.3%, respectively (P=0.002), and the 5-yr OS being 77.7% and 90.3%, respectively (P=0.011).
Conclusions: The commonest recurrence/metastasis sites of stage I NSCLC after anatomic lobectomy are lung, brain and mediastinal lymph nodes, the risk of recurrence/metastasis within 2 years were equal to that between 3 years and 5 years. The follow-up frequencies and content within 2 years could be adjusted according to T stages.
背景与目的 目前国际上对于早期非小细胞肺癌（non-small cell lung cancer, NSCLC）的随访策略（随访间隔时间和随访内容）并未达成共识，相关的临床证据也十分有限。本研究通过I期NSCLC的随访结果，总结其复发转移的部位及时间，为制定该类患者的随访间隔时间和内容提供参考。方法 回顾性分析我科肺癌前瞻性数据库中2000年1月-2013年10月单一医生组连续行解剖性肺叶切除手术的416例I期NSCLC患者，根据复发转移部位及时间，探讨该类患者的长期随访间隔时间和内容。结果 全组患者5年无疾病生存率（disease free survival, DFS）与总生存率（overall survival, OS）分别为82.4%和85.4%；随访期间出现复发转移者共76例（18.3%），复发转移部位中常见者依次为肺转移21例（5.0%）、脑转移20例（4.8%）、骨转移12例（2.9%）和纵隔淋巴结转移12例（2.9%）。影响复发转移的因素中，pT2a者复发转移率高于pT1者（P=0.006），5年DFS分别为73.8%和87.6%（P=0.002），5年OS分别为77.7%和90.3%（P=0.011）。结论 I期NSCLC解剖性肺叶切除术后复发转移以肺、脑、骨及纵隔淋巴结最常见，2年内与3年-5年复发转移风险相当，可以根据T分期调整2年内随访次数及随访内容。 .
Keywords: Follow-up; Lobectomy; Lung neoplasms; Prognosis.