Abstract
Background
Lung cancer is the most common cause of cancer mortality in Korea. The TNM stage at presentation
in patients with non-small cell lung cancer (NSCLC) has the greatest impact on prognosis. Patients who undergo
a complete resection for NSCLC are likely to develop recurrent and/or metastatic disease. There are several factors influencing the development of recurrence. We explored risk factors of recurrence in patients with stages I and II NSCLC, who had undergone curative resection.
Methods
We reviewed patients who had complete surgical resection as definitive treatment for stage I or II. Patients followed up for more than 36 months. We evaluated several factors which might have relationship with recurrence, such as patient's demographic factors, TNM staging, pathologic finding, tumor markers and surgical technique.
Results
A total of 75 patients were enrolled for analysis, of whom 58 were men and 17 were women with mean age of 61 (range, 37 to 76) years. The average size of tumors was 3.9 cm (0.7 to 10 cm). There were 64 patients with stage I NSCLC and 11 with stage II NSCLC. Among 64 patients with stage I NSCLC, 35 patients showed recurrences whereas 8 patients have recurred in stage II NSCLC. Grade of differentiation of tumor was closely related to the recurrence. Seventy-five percent of patients who had poor tumor differentiation experienced a recurrence. In contrast, 3 patients of twelve had recurrences, who revealed differentiation in their tissue (p<0.05).
Figures and Tables
Figure 3
The Kaplan-Meier survival curves in patients with stage I, II non-small cell lung cancer stratified by histologic grades.
![trd-68-10-g003](/upload/SynapseData/ArticleImage/0003trd/trd-68-10-g003.jpg)
Table 4
Relationship between recurrence and clinicopathologic factors in stage I, II non-small cell lung cancer
![trd-68-10-i004](/upload/SynapseData/ArticleImage/0003trd/trd-68-10-i004.jpg)
Table 5
Relationship between recurrence and clinicopathologic factors in stage I non-small cell lung cancer
![trd-68-10-i005](/upload/SynapseData/ArticleImage/0003trd/trd-68-10-i005.jpg)
References
1. Korea National Statistical Office. Annual report on the cause of death statistics, 2007. 2008. Daejeon: Korea National Statistical Office.
2. Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist. 2007. 12:20–37.
3. Asamura H, Goya T, Koshiishi Y, Sohara Y, Tsuchiya R, Miyaoka E. How should the TNM staging system for lung cancer be revised? A simulation based on the Japanese Lung Cancer Registry populations. J Thorac Cardiovasc Surg. 2006. 132:316–319.
4. Visbal AL, Leighl NB, Feld R, Shepherd FA. Adjuvant chemotherapy for early-stage non-small cell lung cancer. Chest. 2005. 128:2933–2943.
5. Winton T, Livingston R, Johnson D, Rigas J, Johnston M, Butts C, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005. 352:2589–2597.
6. Scagliotti G. Multimodality approach to early-stage non-small cell lung cancer. Lung Cancer. 2007. 57:Suppl 2. S6–S11.
7. Ou SH, Zell JA, Ziogas A, Anton-Culver H. Prognostic factors for survival of stage I nonsmall cell lung cancer patients: a population-based analysis of 19,702 stage I patients in the California Cancer Registry from 1989 to 2003. Cancer. 2007. 110:1532–1541.
8. Mountain CF. Revisions in the international system for staging lung cancer. Chest. 1997. 111:1710–1717.
9. Greene FL. AJCC cancer staging manual. 2002. 6th ed. New York: Springer-Verlag.
10. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007. 2:706–714.
11. Rami-Porta R, Crowley JJ, Goldstraw P. The revised TNM staging system for lung cancer. Ann Thorac Cardiovasc Surg. 2009. 15:4–9.
12. Kobayashi N, Toyooka S, Soh J, Ichimura K, Yanai H, Suehisa H, et al. Risk factors for recurrence and unfavorable prognosis in patients with stage I non-small cell lung cancer and a tumor diameter of 20 mm or less. J Thorac Oncol. 2007. 2:808–812.
13. Tsuboi M, Ohira T, Saji H, Miyajima K, Kajiwara N, Uchida O, et al. The present status of postoperative adjuvant chemotherapy for completely resected non-small cell lung cancer. Ann Thorac Cardiovasc Surg. 2007. 13:73–77.
14. Pisters KM, Evans WK, Azzoli CG, Kris MG, Smith CA, Desch CE, et al. Cancer Care Ontario and American Society of Clinical Oncology adjuvant chemotherapy and adjuvant radiation therapy for stages I-IIIA resectable non small-cell lung cancer guideline. J Clin Oncol. 2007. 25:5506–5518.
15. Kita H, Koshiishi Y, Masui K, Fujita A, Ootsuka K, Furuyashiki G, et al. Risk factors of recurrence in resected stage I non-small cell lung cancer. Kyobu Geka. 2007. 60:883–887.
16. Fujisawa T, Yamaguchi Y, Saitoh Y, Hiroshima K, Ohwada H. Blood and lymphatic vessel invasion as prognostic factors for patients with primary resected nonsmall cell carcinoma of the lung with intrapulmonary metastases. Cancer. 1995. 76:2464–2470.
17. Pechet TT, Carr SR, Collins JE, Cohn HE, Farber JL. Arterial invasion predicts early mortality in stage I non-small cell lung cancer. Ann Thorac Surg. 2004. 78:1748–1753.