NEW YORK (Reuters Health) – Patients with non-small-cell lung cancer who have not had a recurrence for 5 years after resection may not yet be free and clear. Some patients with certain tumor characteristics are at significant risk for a late recurrence, a Japanese team reports in Chest for July 1st.
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.”