Characteristics and timing of recurrence during postoperative surveillance after curative resection for lung adenocarcinoma

• Published in: Surgery today (Tokyo, Japan) Vol. 47; no. 12; pp. 1469 - 1475
• Main Authors: Koike, Terumoto, Goto, Tatsuya, Kitahara, Akihiko, Sato, Seijiro, Saitoh, Masayuki, Hashimoto, Takehisa, Namura, Osamu, Takahashi, Masashi, Toyabe, Shin-ichi, Tsuchida, Masanori
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.12.2017
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Bronchoalveolar Lavage Fluid - cytology; Epidemiological Monitoring; Female; Follow-Up Studies; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Original Article; Pleura - pathology; Postoperative Period; Retrospective Studies; Risk Factors; Sex Factors; Surgery; Surgical Oncology; Time Factors; Tomography, X-Ray Computed; Postoperative surveillance; Lung adenocarcinoma; Postoperative follow-up; Postoperative recurrence; Non-small cell lung cancer
• ISSN: 0941-1291; 1436-2813; 1436-2813
• DOI: 10.1007/s00595-017-1537-3

Purpose To establish the most effective methods of postoperative surveillance to detect early recurrence of lung adenocarcinoma. Methods The subjects of this retrospective study were 485 patients with p-stage I–III lung adenocarcinoma, who underwent postoperative surveillance. We examined the sites and detection modes of recurrence and calculated the recurrence-free probabilities. Patients with stage I disease were divided into low- and high-risk recurrence groups using a risk score calculated by assigning points proportional to risk factor regression coefficients. Results Of the 112 patients with recurrence, 86 had intrathoracic recurrence. Routine computed tomography (CT) revealed recurrence in 60 patients. The recurrence-free probability curves showed that 95% of recurrences were identified within the first 4 years after resection in patients with stage II/III disease. In patients with stage I disease, the predictors of recurrence included male sex, positive pleural lavage cytology, moderate-to-poor differentiation, and visceral pleural invasion. Postoperative recurrences were detected throughout the follow-up period in the high-risk group. Conclusions Routine chest CT plays an important role in the postoperative surveillance of lung adenocarcinoma. We recommend intensive follow-up during the early post-resection period for patients with advanced stage disease and long-term follow-up for high-risk patients with stage I disease.