Time-Varying Pattern of Postoperative Recurrence Risk of Early-Stage (T1a-T2bN0M0) Non-Small Cell Lung Cancer (NSCLC): Results of a Single-Center Study of 994 Chinese Patients

• Published in: PloS one Vol. 9; no. 9; p. e106668
• Main Authors: Zhu, Jian-fei, Feng, Xing-yu, Zhang, Xue-wen, Wen, Ying-sheng, Lin, Peng, Rong, Tie-hua, Cai, Ling, Zhang, Lan-jun
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.09.2014; Public Library of Science (PLoS)
• Subjects: Aged; Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Chemotherapy; Chemotherapy, Adjuvant; China; DNA methylation; Female; Health hazards; Health risks; Humans; Identification methods; Lung cancer; Lung diseases; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Medical prognosis; Medicine and Health Sciences; Middle Aged; Neoplasm Staging; Non-small cell lung carcinoma; Patients; Postoperative Period; Recurrence; Retrospective Studies; Review boards; Risk; Subgroups; Surgery; Survival; Survival Analysis; Temporal distribution; Thoracic surgery; Time Factors; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0106668

The aim of this study was to analyze the time-varying pattern of recurrence risk of early-stage (T1a-T2bN0M0) non-small cell lung cancer (NSCLC) after surgery using the hazard function and identify patients who might benefit from adjuvant chemotherapy. This retrospective study enrolled 994 patients with early-stage NSCLC who underwent radical surgical resection between January 1999 and October 2009. Survival curves were generated using the Kaplan-Meier method, and the annual recurrence hazard was estimated using the hazard function. The median recurrence-free survival (RFS) was 8.8 years. The life table survival analysis showed that the 1-year, 3-year, 5-year and 10-year recurrence rates were 82.0%, 67.0%, 59.0% and 48.0%, respectively. Approximately 256 (25.7%) patients experienced relapse [locoregional: 32 (3.2%) and distant: 224 (22.5%)], and 162 patients died from cancer. The annual recurrence hazard curve for the entire population showed that the first major recurrence surge reached a maximum 1.6 years after surgery. The curve subsequently declined until reaching a nadir at 7.2 years. A second peak occurred at 8.8 years. An analysis of clinical-pathological factors demonstrated that this double-peaked pattern was present in several subgroups. The presence of a double-peaked pattern indicates that there is a predictable temporal distribution of the recurrence hazard of early-stage NSCLC. The annual recurrence hazard may be an effective method of selecting patients at high risk of recurrence, who may benefit from adjuvant therapy.