Detection of Recurrence Patterns After Wedge Resection for Early Stage Lung Cancer: Rationale for Radiologic Follow-Up

Overview

Journal Ann Thorac Surg

Publisher Elsevier

Specialties General Surgery
Pulmonary Medicine

Date 2016 Jun 28

PMID 27345095

Citations 6

Authors

Andrea Bille

Usman Ahmad

Kaitlin M Woo

Kei Suzuki

Prasad Adusumilli

James Huang

David R Jones

Nabil Pierre Rizk

Affiliations

Soon will be listed here.

Abstract

Background: Wedge resection for selected patients with early stage non-small cell lung cancer is considered to be a valid treatment option. The aim of this study was to evaluate the recurrence patterns after wedge resection, to analyze the survival of patients under routine follow-up, and to recommend a follow-up regimen.

Methods: A retrospective analysis was done of 446 consecutive patients between May 2000 and December 2012 who underwent a wedge resection for clinical stage I non-small cell lung cancer. All patients were followed up with a computed tomography scan with or without contrast. The recurrence was recorded as local (involving the same lobe of wedge resection), regional (involving mediastinal or hilar lymph nodes or a different lobe), or distant (including distant metastasis and pleural disease).

Results: Median follow-up for survivors (n = 283) was 44.6 months. In all, 163 patients died; median overall survival was 82.6 months. Thirty-six patients were diagnosed with new primary non-small cell lung cancer, and 152 with recurrence (79 local, 45 regional, and 28 distant). There was no difference in the incidence of recurrence detection detected by computed tomography scans with versus without contrast (p = 0.18). The cumulative incidence of local recurrences at 1, 2, and 3 years was higher than the cumulative incidence for local, regional, and distant recurrences: 5.2%, 11.1%, and 14.9% versus 3.7%, 6.6%, and 9.5% versus 2.3%, 4.7%, and 6.4%, respectively. Primary tumor diameter was associated with local recurrence in univariate analysis.

Conclusions: Wedge resection for early stage non-small cell lung cancer is associated with a significant risk for local and regional recurrence. Long-term follow-up using noncontrast computed tomography scans at consistent intervals is appropriate to monitor for these recurrences.

Citing Articles

Collagen 1 Fiber Volume Predicts for Recurrence of Stage 1 Non-Small Cell Lung Cancer.

Kakkad S, Krishnamachary B, Fackche N, Garner M, Brock M, Huang P Tomography. 2024; 10(7):1099-1112.

PMID: 39058055 PMC: 11281282. DOI: 10.3390/tomography10070083.

Impact of Perioperative Multiple Doses of Glucocorticoids on Peripheral Blood Lymphocyte Subsets and Inflammatory Cytokines in Patients With Non-small Cell Lung Cancer.

Yang L, Cai Y, Fu X Front Surg. 2022; 9:859984.

PMID: 35402494 PMC: 8987204. DOI: 10.3389/fsurg.2022.859984.

Target volume definition for staple line recurrences of non-small cell lung cancer.

Nuzhat J, Mukhopadhyay N, Weiss E Rep Pract Oncol Radiother. 2022; 26(6):861-868.

PMID: 34992857 PMC: 8726443. DOI: 10.5603/RPOR.a2021.0090.

Surgery after neoadjuvant immunotherapy in patients with resectable non-small cell lung cancer.

Huynh C, Walsh L, Spicer J Transl Lung Cancer Res. 2021; 10(1):563-580.

PMID: 33569337 PMC: 7867741. DOI: 10.21037/tlcr-20-509.

Detection of Solid Tumor Molecular Residual Disease (MRD) Using Circulating Tumor DNA (ctDNA).

Chin R, Chen K, Usmani A, Chua C, Harris P, Binkley M Mol Diagn Ther. 2019; 23(3):311-331.

PMID: 30941670 PMC: 6561896. DOI: 10.1007/s40291-019-00390-5.

References

Rubins J, Unger M, Colice G . Follow-up and surveillance of the lung cancer patient following curative intent therapy: ACCP evidence-based clinical practice guideline (2nd edition). Chest. 2007; 132(3 Suppl):355S-367S. DOI: 10.1378/chest.07-1390. View

Ginsberg R, Rubinstein L . Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995; 60(3):615-22; discussion 622-3. DOI: 10.1016/0003-4975(95)00537-u. View

Martini N, Melamed M . Multiple primary lung cancers. J Thorac Cardiovasc Surg. 1975; 70(4):606-12. View

Calman L, Beaver K, Hind D, Lorigan P, Roberts C, Lloyd-Jones M . Survival benefits from follow-up of patients with lung cancer: a systematic review and meta-analysis. J Thorac Oncol. 2011; 6(12):1993-2004. DOI: 10.1097/JTO.0b013e31822b01a1. View

Donington J, Ferguson M, Mazzone P, Handy Jr J, Schuchert M, Fernando H . American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. Chest. 2012; 142(6):1620-1635. DOI: 10.1378/chest.12-0790. View

Nakamura R, Kurishima K, Kobayashi N, Ishikawa S, Goto Y, Sakai M . Postoperative follow-up for patients with non-small cell lung cancer. Onkologie. 2010; 33(1-2):14-8. DOI: 10.1159/000264623. View

Ettinger D, Akerley W, Borghaei H, Chang A, Cheney R, Chirieac L . Non-small cell lung cancer. J Natl Compr Canc Netw. 2012; 10(10):1236-71. DOI: 10.6004/jnccn.2012.0130. View

Sugimura H, Nichols F, Yang P, Allen M, Cassivi S, Deschamps C . Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection. Ann Thorac Surg. 2007; 83(2):409-17. DOI: 10.1016/j.athoracsur.2006.08.046. View

Choi S, Kim Y, Kim S, Kang K, Goo J, Kang C . Positron emission tomography-computed tomography for postoperative surveillance in non-small cell lung cancer. Ann Thorac Surg. 2011; 92(5):1826-32. DOI: 10.1016/j.athoracsur.2011.07.005. View

10.

Jacobson F, Austin J, Field J, Jett J, Keshavjee S, MacMahon H . Development of The American Association for Thoracic Surgery guidelines for low-dose computed tomography scans to screen for lung cancer in North America: recommendations of The American Association for Thoracic Surgery Task Force for Lung Cancer.... J Thorac Cardiovasc Surg. 2012; 144(1):25-32. DOI: 10.1016/j.jtcvs.2012.05.059. View

11.

Ujiie H, Kadota K, Chaft J, Buitrago D, Sima C, Lee M . Solid Predominant Histologic Subtype in Resected Stage I Lung Adenocarcinoma Is an Independent Predictor of Early, Extrathoracic, Multisite Recurrence and of Poor Postrecurrence Survival. J Clin Oncol. 2015; 33(26):2877-84. PMC: 4554749. DOI: 10.1200/JCO.2015.60.9818. View

12.

Nitadori J, Bograd A, Kadota K, Sima C, Rizk N, Morales E . Impact of micropapillary histologic subtype in selecting limited resection vs lobectomy for lung adenocarcinoma of 2cm or smaller. J Natl Cancer Inst. 2013; 105(16):1212-20. PMC: 3748005. DOI: 10.1093/jnci/djt166. View

13.

Younes R, Gross J, Deheinzelin D . Follow-up in lung cancer: how often and for what purpose?. Chest. 1999; 115(6):1494-9. DOI: 10.1378/chest.115.6.1494. View

14.

Lou F, Sima C, Rusch V, Jones D, Huang J . Differences in patterns of recurrence in early-stage versus locally advanced non-small cell lung cancer. Ann Thorac Surg. 2014; 98(5):1755-60. PMC: 4256682. DOI: 10.1016/j.athoracsur.2014.05.070. View

15.

Lamont J, Kakuda J, Smith D, Wagman L, Grannis Jr F . Systematic postoperative radiologic follow-up in patients with non-small cell lung cancer for detecting second primary lung cancer in stage IA. Arch Surg. 2002; 137(8):935-8; discussion 938-40. DOI: 10.1001/archsurg.137.8.935. View

16.

Crino L, Weder W, Van Meerbeeck J, Felip E . Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010; 21 Suppl 5:v103-15. DOI: 10.1093/annonc/mdq207. View

17.

Westeel V, Choma D, Clement F, Woronoff-Lemsi M, Pugin J, Dubiez A . Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer. Ann Thorac Surg. 2000; 70(4):1185-90. DOI: 10.1016/s0003-4975(00)01731-8. View

18.

Lou F, Huang J, Sima C, Dycoco J, Rusch V, Bach P . Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance. J Thorac Cardiovasc Surg. 2012; 145(1):75-81. DOI: 10.1016/j.jtcvs.2012.09.030. View