Dr. Junji Yoshida and colleagues with the National Cancer Center Hospital East in Chiba analyzed data on 1358 patients who underwent complete resection of NSCLC with systematic lymph node dissection; 819 of them were free of recurrence for 5 years.
Subsequently, 87 of these patients (11%) had a late recurrence.
“Five years is not enough.” Dr. Yoshida commented in an email to Reuters Health. “This is both for patient follow-up and for outcome evaluation. Five years has been the standard for the both in lung cancer, but we showed there were a significant percentage of NSCLC patients developing recurrence beyond 5 years after surgical resection.”
On multivariate analysis, the team found that factors disposing to recurrence more than 5 years after resection were intratumoral vascular invasion and nodal involvement.
Specifically, they report, “The 5-year recurrence-free probabilities from the point of 5 years after primary tumor resection were 81% for patients with intratumoral vascular invasion (p<0.001), and 89%, 84%, and 65% for patients with N0, N1, and N2 cancers, respectively (p<0.001).”
“Patients with vascular invasion positive tumors are at almost a 2-fold risk and those with nodal involvement tumors are at a 4-fold risk of a late recurrence,” Dr. Yoshida stated.
Summing up, he said, “Similarly to colorectal cancer, we need to follow lung cancer patients beyond 5 years and to evaluate treatment outcome based on 10-year follow-up.”
Dr. Yoshida and his colleagues add, “This has implications for whether scheduled longterm follow-up beyond 5 years is warranted, or whether patients should simply be counseled on symptom recognition.”
Reference:
Chest 2010;138:145–150.
