Risk Factors for Local and Distant Recurrence After Surgical Treatment in Patients With Non–Small-Cell Lung Cancer

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The aim of the study was to evaluate risk factors for local and distant recurrence after surgical treatment of non–small-cell lung cancer. A total of 14,578 patients met the inclusion criteria and had complete follow-up information. Analysis indicated independent effects of the following risk factors on the risk of recurrence: age 64–90 years, histologic type of adenocarcinoma, blood vessel invasion, lymphatic vessel invasion, visceral pleural invasion, N1 or N2 disease, tumor size of 20–30 mm, 30–50 mm, 50–70 mm, and 70–100 mm, pneumonectomy, and sublobar resection.


The purpose of this study was to identify independent perioperative and pathologic variables associated with non–small-cell lung cancer (NSCLC) recurrence after complete surgical resection.

Patients and Methods:

A retrospective examination was performed of a prospectively maintained database of patients who underwent resection for NSCLC from January 2009 to January 2014 at a multi-institution. Clinicopathologic variables were evaluated for their influence on frequency of recurrence. Cox proportional regression hazard model analysis examined the association of recurrence in NSCLC.


Of these patients, 2816 (19.3%) experienced recurrence of primary cancer. Local or distant recurrence was found in 20.5% and 79.5% of patients, respectively. Median follow-up was 27.9 months (range, 11.4–66.0 months). The analysis indicated independent effects of the following risk factors on the risk of recurrence: age 64–90 years (hazard ratio [HR], 1.136; 95% confidence interval [CI] 1.024–1.261), histologic type adenocarcinoma (HR, 1.117; 95% CI 1.005–1.24), blood vessel invasion (HR, 1.236; 95% CI, 1.124–1.359), lymphatic vessel invasion (HR, 1.287; 95% CI, 1.176–1.409), visceral pleural invasion (HR, 1.641; 95% CI, 1.215–2.218), N1 disease (HR, 1.142; 95% CI, 0.99–1.316), N2 disease (HR, 1.596; 95% CI, 1.271–1.649), tumor size of 20–30 mm (HR, 1.235; 95% CI, 1.081–1.41), 30–50 mm (HR, 1.544; 95% CI, 1.33–1.792), 50–70 mm (HR, 1.521; 95% CI, 1.275–1.815), and 70–100 mm (HR, 1.71; 95% CI, 1.385–2.11), pneumonectomy (HR, 1.08; 95% CI, 0.97–1.203), and sublobar resection (HR, 1.762; 95% CI, 1.537–2.019).


In the largest series reported to date on postresection recurrence of NSCLC, increasing pathologic stage, advanced age, pneumonectomy, sublobar resection, lymphatic and blood vessel invasion, and visceral pleural invasion were independently associated with local and distant recurrence.

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