Predictors of distant, local and lymph node recurrence for surgically treated non-small cell lung cancer (NSCLC) patients: Retrospective analysis of pathological T1-4, N0, R0, M0 tumor stages.

BACKGROUND

Lung cancer has a high recurrence rate after successful surgical treatment. This study deals with possible risk factors and recommendations to improve the treatment of non-small cell lung cancer (NSCLC).

METHODS

In this retrospective analysis, we used data of all NSCLC patients who underwent lobectomy at the Lung Cancer Center Munich between 2011 and 2020. Only patients with postoperative T1-4, N0, R0, M0 were included. We compared numerical outcomes between patients with distant, lymph node, local recurrence and no recurrence using analysis of variance (ANOVA), and categorical outcomes using Chi-squared test or Fisher's exact test when cell numbers were <6. We used logistic regression models to identify factors significantly associated with the occurrence of a distant, lymph node and local recurrence.

RESULTS

Tumor size in cm was significantly higher in patients with local recurrence (mean 5.5) followed by distant recurrence (mean 4.0), lymph node recurrence (mean 3.1) and patients with no recurrence (mean 3.0), p<0.0001. Diffusing capacity for carbon monoxide (DLCO) in % was significantly higher in patients with no recurrence (72.9) and decreased with distant recurrence (67.0), local recurrence (66.7) and lymph node recurrence (65.8), p=0.01. There were no significant differences in postoperative complications, surgical approach or number of lymph node assessed. A tumor size ≥4.65 cm was identified as an independent marker for local recurrence.

CONCLUSION

For patients with NSCLC ≥4.65 cm, which corresponds to UICC stage IIA and higher, multimodal therapy should be discussed. The surgical approach has no influence on recurrence.