Long-term survival after surgical resection for non-small cell lung cancer

Abstract

<b>Introduction:</b> Surgical resection is recommended treatment in patients with early-stage non-small cell lung cancer (NSCLC). In addition to tumor stage and biology, various risk factors contribute to postoperative mortality. <b>Aims and objectives:</b> We have investigated risk factors for all-cause mortality. In addition we evaluated risk factors for specific causes of death due to lung cancer, cardiovascular disease and other causes. <b>Methods:</b> We individually assessed risk factors affecting overall and cause-specific mortality in a Cox’ proportional hazards model in a cohort of stage I/II NSCLC patients (n=756, 381 females, 375 males, -mean age at surgery 66 years) treated from 2007-2015 in a tertiary university center. Median follow-up was 7.3 years and ended at 9.3 years. <b>Results:</b> Risk factors predicting mortality for all causes of death and death due to NSCLC were increasing age, severely reduced lung function, ECOG ≥2, preoperative examination without FDG-PET/CT, tumor histology (large cell carcinoma, adenosquamous cell carcinoma, carcinoma-NOS) and increasing tumor stage. Patients dying of cardiovascular disease were few (n=19) and therefore included in the other cause group. In patients dying of other causes, age, gender, BMI, smoking and ECOG ≥2 affected mortality. At the end of follow-up there was 35% risk of dying from lung cancer and 20% risk of dying of other causes. Risk of cardiovascular death was 3%. Overall survival was 74%, 62% and 41% at 3, 5 and 9 years, respectively. <b>Conclusions:</b> Our study documented continued risk of lung cancer death beyond 5 years after resection. This may contribute to future guidelines, especially in terms of duration of follow-up in surgically resected lung cancer patients.