Abstract
BackgroundTo investigate clinicopathological variables influencing overall survival, overall recurrence, and post-recurrence survival (PRS) in patients who experienced curative-intent surgical resection of stage I non-small-cell lung cancer (NSCLC).MethodsWe investigated a series of 1387 patients with stage I NSCLC who underwent surgical resection from 2008 to 2015. The effect clinicopathological factors on death, recurrence, and PRS were evaluated by Kaplan-Meier estimates and cox regression analysis.ResultsAmong the 1387 stage I patients, 301 (21.7%) experienced recurrence. The 5-year cumulative incidence of recurrence (CIR) for all patients was 20.2% and median PRS was 25.5 months. The older age (P = 0.036), p-stage IB (P = 0.001), sublobar resection(P<0.001), histology subtype (P<0.001), and lymphovascular invasion (LVI) (P = 0.042) were significantly associated with worse overall survival. Among 301 recurrent patients, univariable analysis indicated that p-stage IB (versus IA) (P<0.001), LVI (P<0.001) and visceral pleural invasion (VPI) (P<0.001) were remarkably correlated with the higher incidence of recurrence. Taking the effect of clinicopathological variables on PRS into consideration, smoking history (P = 0.043), non-adenocarcinoma (P = 0.013), high architectural grade of LUAD (P = 0.019), EGFR wild status (P = 0.002), bone metastasis (P =0.040) and brain metastasis (P = 0.042) were substantially related with poorer PRS. Multivariate analysis demonstrated that high architectural grade of LUAD (P = 0.008), brain metastasis (P = 0.010) and bone metastasis (P = 0.043) were independently associated with PRS.ConclusionIn patients with resected stage I NSCLC, the older age, p-stage IB (versus IA), sublobar resection, histology subtype, and LVI were significantly associated with worse overall survival. P-stage IB (versus IA), LVI, and VPI were significantly correlated with the higher incidence of recurrence. High architectural grade of LUAD, brain metastasis and bone metastasis were independent risk factors with PRS.
Highlights
To investigate clinicopathological variables influencing overall survival, overall recurrence, and postrecurrence survival (PRS) in patients who experienced curative-intent surgical resection of stage I non-small-cell lung cancer (NSCLC)
The older age (HR: 1.169, 95%CI: 1.010–1.352; P = 0.036), p-stage IB (HR: 1.217, 95%CI: 1.106–1.461; P = 0.001), sublobar resection (HR: 1.548, 95%CI: 1.280–1.871; P
We examined the impact of clinicopathological variables on OS and overall recurrence and identified a number of risk factors that were significantly associated with worse OS including the older age (P = 0.036), p-stage IB (P = 0.001), sublobar resection(P
Summary
To investigate clinicopathological variables influencing overall survival, overall recurrence, and postrecurrence survival (PRS) in patients who experienced curative-intent surgical resection of stage I non-small-cell lung cancer (NSCLC). The standard of care for patients with early-stage nonsmall-cell lung cancer (NSCLC) is the curative-intent anatomic surgical resection, whereas tumor metastasis or recurrence leads to the treatment failure and mortality after surgery [3]. According to outcomes of the National Lung Screening Trial (NLST) and the Nelson trials for screening computed tomography (CT) scans, the improvements in the early diagnosis and the reduction in the mortality of lung cancer have been greatly anticipated [8, 9] Appropriate surveillance strategies such as CT scans are of great importance to identify earlier and to screen recurrent patients who have the high probability of mortality. Identification of prognostic variables for recurrence in lung cancer after surgery is of great significance for screening high-risk patients for further and better treatments
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