Abstract
BackgroundThe aim of this study was to analyze the time-varying pattern of recurrence risk of early-stage (T1a-T2bN0M0) non-small cell lung cancer (NSCLC) after surgery using the hazard function and identify patients who might benefit from adjuvant chemotherapy.Patients and MethodsThis retrospective study enrolled 994 patients with early-stage NSCLC who underwent radical surgical resection between January 1999 and October 2009. Survival curves were generated using the Kaplan-Meier method, and the annual recurrence hazard was estimated using the hazard function.ResultsThe median recurrence-free survival (RFS) was 8.8 years. The life table survival analysis showed that the 1-year, 3-year, 5-year and 10-year recurrence rates were 82.0%, 67.0%, 59.0% and 48.0%, respectively. Approximately 256 (25.7%) patients experienced relapse [locoregional: 32 (3.2%) and distant: 224 (22.5%)], and 162 patients died from cancer. The annual recurrence hazard curve for the entire population showed that the first major recurrence surge reached a maximum 1.6 years after surgery. The curve subsequently declined until reaching a nadir at 7.2 years. A second peak occurred at 8.8 years. An analysis of clinical-pathological factors demonstrated that this double-peaked pattern was present in several subgroups.ConclusionsThe presence of a double-peaked pattern indicates that there is a predictable temporal distribution of the recurrence hazard of early-stage NSCLC. The annual recurrence hazard may be an effective method of selecting patients at high risk of recurrence, who may benefit from adjuvant therapy.
Highlights
Screening with low-dose computed tomography (CT) has resulted in a growing number of early-stage non-small cell lung cancer (NSCLC) diagnoses [1]
Curative surgical resection is the current treatment of choice for early-stage NSCLC, the risk of locoregional and distant relapse remains high, at 22%–40% [2,3,4]
The cases selected for this study fulfilled the following criteria: (1) histological confirmed primary NSCLC; (2) no evidence of metastatic disease, as determined by history, physical examination and routine computed tomography (CT); (3) complete surgical resection (R0) at our cancer center; and (4) at least 3 months of follow-up information concerning disease recurrence and death
Summary
Screening with low-dose computed tomography (CT) has resulted in a growing number of early-stage non-small cell lung cancer (NSCLC) diagnoses [1]. The risk of recurrence is analyzed using survival curves rather than hazard functions [5,6]. The hazard function, which depicts the rate of recurrence at any point in time among the remaining at-risk individuals, has been applied to provide insights into the patterns of recurrence of breast cancer [7,8] and gastric cancer [9]. The aim of this study was to analyze the time-varying pattern of recurrence risk of early-stage (T1a-T2bN0M0) non-small cell lung cancer (NSCLC) after surgery using the hazard function and identify patients who might benefit from adjuvant chemotherapy
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