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Identification of Subsets of Patients with Favorable Prognosis After Recurrence in Completely Resected Non-Small Cell Lung Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This retrospective study aimed to determine prognostic factors associated with postrecurrence survival of completely resected non-small cell cancer patients with postoperative recurrence.

Methods

Characteristics, treatment modality, and postrecurrence survival of 234 patients (157 males and 77 females, mean age at recurrence: 68.7 years, 152 adenocarcinomas and 82 non-adenocarcinomas), who underwent complete resection for non-small cell lung cancer between 2003 and 2009 at our hospital and experienced recurrence, were analyzed for prognostic factors. Cox proportional hazard model was applied for multivariate analysis.

Results

Among 234 patients, the median survival time after the diagnosis of recurrence was 21 months, and the 5-year postrecurrence survival rate was 19.9 %. Eastern Cooperative Oncology Group Performance Status (ECOG PS) (hazard ratio [HR]: ECOG PS-0/PS-1/PS-2 = 1/3.313/7.622), time to recurrence after surgery (HR: >2 years/1–2 years/<1 year = 1/1.881/2.185), and number of initial recurrent organs (HR: 1 organ/2 organs/3 or more organs = 1/1.896/2.818) were independent prognostic factors. Patients who received resection or stereotactic irradiation for limited number of brain metastases or solitary extracranial metastasis, and those who received mediastinal radiation or chemoradiation for recurrence at regional lymph nodes and/or resected stump had better survival (median survival time after recurrence: 34, 64, and 25 months, respectively).

Conclusions

Poor ECOG PS, shorter time from initial surgery to recurrence, and increasing number of initial recurrent regions are associated with poor prognosis after recurrence. When the number of recurrent lesions is limited, intensive local treatment with curative intent should be applied for achieving long-term postrecurrence survival.

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References

  1. Sawabata N, Miyaoka E, Asamura H, Nakanishi Y, Eguchi K, Mori M, et al. Japanese Joint Committee for Lung Cancer Registration., Japanese lung cancer registry study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade. J Thorac Oncol. 2011;6:1229–35.

    Google Scholar 

  2. Williams BA, Sugimura H, Endo C, Nichols FC, Cassivi SD, Allen MS, et al. Predicting postrecurrence survival among completely resected nonsmall-cell lung cancer patients. Ann Thorac Surg. 2006;81:1021–7.

    Article  PubMed  Google Scholar 

  3. Sugimura H, Nichols FC, Yang P, Allen MS, Cassivi SD, Deschamps C, et al. Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection. Ann Thorac Surg. 2007;83:409–17.

    Article  PubMed  Google Scholar 

  4. Shimada Y, Saji H, Yoshida K, Kakihana M, Honda H, Nomura M, et al. Prognostic factors and the significance of treatment after recurrence in completely resected stage I non-small cell lung cancer. Chest. 2013;143:1626–34.

    CAS  PubMed  Google Scholar 

  5. Non-Small Cell Lung Cancer Collaborative Group. Chemotherapy and supportive care versus supportive care alone for advanced non-small cell lung cancer. Cochrane Database Syst Rev. 12 May 2010:5:CD007309. doi:10.1002/14651858.

  6. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13:8–10.

    CAS  PubMed  Google Scholar 

  7. Niibe Y, Hayakawa K. Oligometastases and oligo-recurrence: the new era of cancer therapy. Jpn J Clin Oncol. 2010;40:107–11.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Yano T, Haro A, Yoshida T, Morodomi Y, Ito K, Shikada Y, et al. Prognostic impact of local treatment against postoperative oligometastases in non-small cell lung cancer. J Surg Oncol. 2010;102:852–5.

    Article  PubMed  Google Scholar 

  9. Okubo K, Bando T, Miyahara R, Sakai H, Shoji T, Sonobe M, et al. Resection of pulmonary metastasis of non-small cell lung cancer. J Thorac Oncol. 2009;4:203–7.

    Article  PubMed  Google Scholar 

  10. Salah S, Tanvetyanon T, Abbasi S. Metastatectomy for extra-cranial extra-adrenal non-small cell lung cancer solitary metastases: systematic review and analysis of reported cases. Lung Cancer. 2012;75:9–14.

    Article  PubMed  Google Scholar 

  11. Kavanagh BD, McGarry RC, Timmerman RD. Extracranial radiosurgery (stereotactic body radiation therapy) for oligometastases. Semin Radiat Oncol. 2006;16:77–84.

    Article  PubMed  Google Scholar 

  12. Flannery TW, Suntharalingam M, Regine WF, Chin LS, Krasna MJ, Shehata MK, et al. Long-term survival in patients with synchronous, solitary brain metastasis from non-small-cell lung cancer treated with radiosurgery. Int J Radiat Oncol Biol Phys. 2008;72:19–23.

    Article  PubMed  Google Scholar 

  13. Kawabe T, Phi JH, Yamamoto M, Kim DG, Barfod BE, Urakawa Y. Treatment of brain metastasis from lung cancer. Prog Neurol Surg. 2012;25:148–55.

    Article  PubMed  Google Scholar 

  14. Colby TV, Noguchi M, Henshke C, Vazquez MF, Geisinger K, Yokose T, et al. Adenocarcinoma. In: Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC, eds. World Health Organization classification of tumours: pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon, France: IARC Press, 2004:35–44.

    Google Scholar 

  15. Vallières E, Shepherd FA, Crowley J, Van Houtte P, Postmus PE, Carney D, et al. International Association for the Study of Lung Cancer International Staging Committee and Participating Institutions. The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4:1049–59.

    Article  PubMed  Google Scholar 

  16. Sonobe M, Manabe T, Wada H, Tanaka F. Mutations in the epidermal growth factor receptor gene are linked to smoking-independent, lung adenocarcinoma. Brit J Cancer. 2005;93:355–63.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Antakli T, Schaefer RF, Rutherford JE, Read RC. Second primary lung cancer. Ann Thorac Surg. 1995;59:863–6.

    Article  CAS  PubMed  Google Scholar 

  18. Hoang T, Xu R, Schiller JH, Bonomi P, Johnson DH. Clinical model to predict survival in chemonaive patients with advanced non-small-cell lung cancer treated with third-generation chemotherapy regimens based on eastern cooperative oncology group data. J Clin Oncol. 2005;23:175–83.

    Article  CAS  PubMed  Google Scholar 

  19. Westeel V, Choma D, Clément F, Woronoff-Lemsi MC, Puqin JF, Dubiez A, et al. Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer. Ann Thorac Surg. 2000;70:1185–90.

    Article  CAS  PubMed  Google Scholar 

  20. Hotta K, Sekine I, Suzuki K, Kondo H, Asamura H, Sumi M, et al. Distant failure after treatment of postoperative locoregional recurrence of non-small cell lung cancer. Thorac Cardiovasc Surg. 2003;51:283–7.

    Article  CAS  PubMed  Google Scholar 

  21. Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002;346:92–8.

    Article  CAS  PubMed  Google Scholar 

  22. American Society of Clinical Oncology: Clinical practice guidelines for the treatment of unresectable non-small-cell lung cancer. J Clin Oncol. 1997;15:2996–3018.

    Google Scholar 

  23. Bunn PA Jr. Chemotherapy for advanced non-small-cell lung cancer: who, what, when, why? J Clin Oncol. 2002;20:23S–33S.

    CAS  PubMed  Google Scholar 

  24. Walsh GL, O’Connor M, Willis KM, Milas M, Wong RS, Nesbitt JC, et al. Is follow-up of lung cancer patients after resection medically indicated and cost-effective? Ann Thorac Surg. 1995;60:1563–70.

    Article  CAS  PubMed  Google Scholar 

  25. Sonobe M, Nakagawa M, Takenaka K, Katakura H, Adachi M, Yanagihara K, et al. Influence of epidermal growth factor receptor (EGFR) gene mutations on the expression of EGFR, phosphoryl-Akt, and phosphoryl-MAPK, and on the prognosis of patients with non-small cell lung cancer. J Surg Oncol. 2007;95:63–9.

    Article  CAS  PubMed  Google Scholar 

  26. Sonobe M, Kobayashi M, Ishikawa M, Kikuchi R, Nakayama E, Takahashi T, et al. Impact of KRAS and EGFR gene mutations on recurrence and survival in patients with surgically resected lung adenocarcinomas. Ann Surg Oncol. 2012;19:S347–54.

    Article  PubMed  Google Scholar 

  27. Burt M, Wronski M, Arbit E, Galicich JH. Resection of brain metastases from non-small-cell lung carcinoma. Results of therapy. Memorial Sloan-Kettering Cancer Center Thoracic Surgical Staff. J Thorac Cardiovasc Surg. 1992;103:399–410.

    CAS  PubMed  Google Scholar 

  28. Mehta M, Manon R. Are more aggressive therapies able to improve treatment of locally advanced non-small cell lung cancer: combined modality treatment? Semin Oncol. 2005;32:S25–34.

    Article  PubMed  Google Scholar 

  29. Sakamoto J, Sonobe M, Kobayashi M, Ishikawa M, Kikuchi R, Nakajima D, et al. Prognostic factors for patients in postoperative brain metastases from surgically resected non-small cell lung cancer. Int J Clin Oncol. 2014;19:50–6.

    Article  CAS  PubMed  Google Scholar 

  30. Porte H, Siat J, Guibert B, Lepimpec-Barthes F, Jancovici R, Bernard A, et al. Resection of adrenal metastases from non-small cell lung cancer: a multicenter study. Ann Thorac Surg. 2001;71:981–5.

    Article  CAS  PubMed  Google Scholar 

  31. Carey Sampson M, Katz A, Constine LS. Stereotactic body radiation therapy for extracranial oligometastases: does the sword have a double edge? Semin Radiat Oncol. 2006;16:67–76.

    Article  PubMed  Google Scholar 

  32. Bezjak A, Payne D. Radiotherapy in the management of non-small-cell lung cancer. World J Surg. 1993;17:741–50.

    Article  CAS  PubMed  Google Scholar 

  33. Aupérin A, Le Péchoux C, Rolland E, Curran WJ, Furuse K, Fournel P, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol. 2010;28:2181–90.

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors thank the members of the Department of Respiratory Medicine, Department of Radiation Oncology and Image-Applied Therapy, Department of Therapeutic Oncology, and Department of Neurosurgery, Kyoto University Hospital for their many suggestions toward the management of patients with recurrent lung cancer. There were no funding sources supporting the work.

Disclosure

We certify that none of the authors have any commercial associations that might pose a conflict of interest in connection with the study. We affirm that this study received no external funding or any support from institutional or corporate affiliations.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan

    Makoto Sonobe MD, PhD, Tetsu Yamada MD, PhD, Masaaki Sato MD, PhD, Toshi Menju MD, PhD, Akihiro Aoyama MD, PhD, Toshihiko Sato MD, PhD, Fengshi Chen MD, PhD, Mitsugu Omasa MD, PhD, Toru Bando MD, PhD & Hiroshi Date MD, PhD

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  1. Makoto Sonobe MD, PhD
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  2. Tetsu Yamada MD, PhD
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  3. Masaaki Sato MD, PhD
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  4. Toshi Menju MD, PhD
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  5. Akihiro Aoyama MD, PhD
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  6. Toshihiko Sato MD, PhD
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  7. Fengshi Chen MD, PhD
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  8. Mitsugu Omasa MD, PhD
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  9. Toru Bando MD, PhD
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  10. Hiroshi Date MD, PhD
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Correspondence to Makoto Sonobe MD, PhD.

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Sonobe, M., Yamada, T., Sato, M. et al. Identification of Subsets of Patients with Favorable Prognosis After Recurrence in Completely Resected Non-Small Cell Lung Cancer. Ann Surg Oncol 21, 2546–2554 (2014). https://doi.org/10.1245/s10434-014-3630-9

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  • DOI: https://doi.org/10.1245/s10434-014-3630-9

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