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Chest. 2013 May;143(5):1365-1377. doi: 10.1378/chest.12-0710.

Identification of stage I non-small cell lung cancer patients at high risk for local recurrence following sublobar resection.

Author information

1
Penn State Hershey Cancer Institute, Hershey, PA. Electronic address: jvarlotto@hmc.psu.edu.
2
Harvard Medical School, Boston, MA.
3
Harvard Medical School, Boston, MA; Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA.
4
Department of Radiation Oncology, Pittsburgh Cancer Institute, Pittsburgh, PA.
5
Department of Health Policy and Administration, Pennsylvania State University, University Park, PA.
6
Pennsylvania State College of Medicine, Hershey, PA.
7
Penn State Heart and Vascular Institute, Hershey, PA.
8
Penn State Hershey Pulmonary Medicine, Hershey, PA.
9
Penn State Hershey Medical Center, Hershey, PA.
10
Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, IL.

Abstract

OBJECTIVE:

An increasing proportion of patients with stage I non-small cell lung cancer (NSCLC) is undergoing sublobar resection (L-). However, there is little information about the risks and correlates of local recurrence (LR) after such surgery, especially compared with patients undergoing lobectomy (L+).

METHODS:

Ninety-three and 318 consecutive patients with stage I NSCLC underwent L- and L+, respectively, from 2000 to 2006. Median follow-up was 34 months.

RESULTS:

In the L- group, the LR rates at 2, 3, and 5 years were 13%, 24%, and 40%, respectively. The risk of LR was significantly associated with tumor grade, tumor size, and T stage. The crude risk of LR was 33.8% (21 of 62) for patients whose tumors were grade ≥ 2. In the L+ group, the LR rates at 2, 3, and 5 years were 14%, 19%, and 24%, respectively. The risk of LR significantly increased with increasing tumor size, length of hospital stay, and the presence of diabetes. The L- group experienced a significant increase in failure in the bronchial stump/staple line compared with the L+ group (10% vs 3%; P = .04) and nonsignificant trends toward increased ipsilateral hilar and subcarinal failure rates.

CONCLUSIONS:

Patients with stage I NSCLC who undergo L- have an increased risk of LR compared with patients undergoing L+, particularly when they have tumors grade ≥ 2 or tumor size > 2 cm. If L- is considered, additional local therapy should be considered to reduce this risk of LR, especially with tumors grade ≥ 2 or size > 2 cm.

PMID:
23715196
DOI:
10.1378/chest.12-0710
[Indexed for MEDLINE]

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