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Recurrence After Surgery for Non-small-cell Lung Cancer in the National Lung Screening Trial.
Pubmed ID
37356517 (View this publication on the PubMed website)
Digital Object Identifier
Ann Thorac Surg. 2023 Jun 23
Potter AL, Costantino CL, Suliman RA, Haridas CS, Senthil P, Kumar A, Mayne NR, Panda N, Martin LW, Jeffrey Yang CF
  • Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
  • Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Department of Medicine, Duke University, Durham, NC, USA.
  • Department of Surgery, University of Virginia, Charlottesville, VA, USA.
  • Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address:

BACKGROUND: To evaluate patterns, predictors, and long-term outcomes of recurrent disease after complete resection for early-stage non-small-cell lung cancer (NSCLC) using the National Lung Screening Trial (NLST).

METHODS: The frequency of recurrence in patients with pathologic stage I-II NSCLC who underwent complete resection (lobectomy or bilobectomy) in the NLST were evaluated. Predictors of increased risk of recurrence were assessed using Fine-Gray competing risks regression. Overall survival of patients with and without recurrence were evaluated using the Kaplan-Meier method.

RESULTS: Of the 497 patients meeting study inclusion criteria, 94 experienced a recurrence-a rate of 4.9 (95% CI: 4.0 to 6.0) per 100 person-years. The 5-year cumulative incidence of recurrence was 20.1% (95% CI: 16.5% to 23.9%). The majority of patients experienced recurrences at distant sites alone (n=47, 50.0%) or at both locoregional and distant sites (n=30, 31.9%). The median time from surgery to recurrence was 18.8 (10.6-30.7) months. In multivariable-adjusted analysis, compared to lung cancers detected via LDCT screening, lung cancers detected via chest x-ray and lung cancers detected during follow-up were associated with a similar risk of recurrence. Median survival of patients with pathologic stage I and II disease who had recurrences at locoregional, distant, or both sites was 63.0, 23.1, and 9.8 months and 28.9, 8.7, and 10.2 months, respectively.

CONCLUSIONS: In this analysis of NLST participants with completely resected stage I-II NSCLC, the 5-year cumulative incidence of recurrence was 20%. Nearly 82% of recurrences were at distant sites and were associated with poor survival.

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