Identification of Stage I Non-small Cell Lung Cancer Patients at High Risk for Local Recurrence Following Sublobar Resection
Objective An increasing proportion of patients with stage I non-small cell lung cancer (NSCLC) is undergoing sublobar resection (L−). However, there is little information about the risks and correlates of local recurrence (LR) after such surgery, especially compared with patients undergoing lobectom...
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| Veröffentlicht in: | Chest 2013-05, Vol.143 (5), p.1365-1377 |
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| creator | Varlotto, John M., MD Medford-Davis, Laura N., MD Recht, Abram, MD Flickinger, John, MD Yao, Nengliang, PhD Hess, Clayton, MD Reed, Michael F., MD, FCCP Toth, Jennifer, MD Zander, Dani S., MD, FCCP DeCamp, Malcolm M., MD, FCCP |
| description | Objective An increasing proportion of patients with stage I non-small cell lung cancer (NSCLC) is undergoing sublobar resection (L−). However, there is little information about the risks and correlates of local recurrence (LR) after such surgery, especially compared with patients undergoing lobectomy (L+). Methods Ninety-three and 318 consecutive patients with stage I NSCLC underwent L− and L+, respectively, from 2000 to 2006. Median follow-up was 34 months. Results In the L− group, the LR rates at 2, 3, and 5 years were 13%, 24%, and 40%, respectively. The risk of LR was significantly associated with tumor grade, tumor size, and T stage. The crude risk of LR was 33.8% (21 of 62) for patients whose tumors were grade ≥ 2. In the L+ group, the LR rates at 2, 3, and 5 years were 14%, 19%, and 24%, respectively. The risk of LR significantly increased with increasing tumor size, length of hospital stay, and the presence of diabetes. The L− group experienced a significant increase in failure in the bronchial stump/staple line compared with the L+ group (10% vs 3%; P = .04) and nonsignificant trends toward increased ipsilateral hilar and subcarinal failure rates. Conclusions Patients with stage I NSCLC who undergo L− have an increased risk of LR compared with patients undergoing L+, particularly when they have tumors grade ≥ 2 or tumor size > 2 cm. If L− is considered, additional local therapy should be considered to reduce this risk of LR, especially with tumors grade ≥ 2 or size > 2 cm. |
| doi_str_mv | 10.1378/chest.12-0710 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1356954542</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0012369213603360</els_id><sourcerecordid>1356954542</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-58c809ca6362cd4d203e6add42b99e3e4886f16d1b03ff9445aaec84add567c3</originalsourceid><addsrcrecordid>eNo9kb1v2zAQxYkiReO4HbsWHLMoIUWKlpYCgRE3Boy2sL0TFHWy6dCiS0opAvSPzylOOvD7d4947wj5ytkNF7Py1u4h9Tc8z9iMsw9kwivBM1FIcUEmjOG9UFV-Sa5SOjA880p9Ipe5mPECtxPyb9lA17vWWdO70NHQ0k1vdkCX9GfosnQ03tM54LQauh2dm85CpL8RxrJETU8f3G5P1y490jZEugrWeLoGO8QIyNJF8D78dVi7GWofahPxNYEdf_tMPrbGJ_jytk7JdnG_nT9kq18_lvO7VWYll31WlLZklTVKqNw2ssmZAGWaRuZ1VYEAWZaq5arhNRNtW0lZGAO2lIgUambFlFyfZU8x_BkwLn10yaIn00EYkuaiUFUhC5kjmp1RG0NKEVp9iu5o4rPmTI9569e8Nc_1mDfy396kh_oIzX_6PWAEvp8BQH9PDqK23nWYtn-EZ0iHMMQOrWuuE0rqzdiysWNcKCbG8QLLfZHS</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1356954542</pqid></control><display><type>article</type><title>Identification of Stage I Non-small Cell Lung Cancer Patients at High Risk for Local Recurrence Following Sublobar Resection</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><source>Alma/SFX Local Collection</source><creator>Varlotto, John M., MD ; Medford-Davis, Laura N., MD ; Recht, Abram, MD ; Flickinger, John, MD ; Yao, Nengliang, PhD ; Hess, Clayton, MD ; Reed, Michael F., MD, FCCP ; Toth, Jennifer, MD ; Zander, Dani S., MD, FCCP ; DeCamp, Malcolm M., MD, FCCP</creator><creatorcontrib>Varlotto, John M., MD ; Medford-Davis, Laura N., MD ; Recht, Abram, MD ; Flickinger, John, MD ; Yao, Nengliang, PhD ; Hess, Clayton, MD ; Reed, Michael F., MD, FCCP ; Toth, Jennifer, MD ; Zander, Dani S., MD, FCCP ; DeCamp, Malcolm M., MD, FCCP</creatorcontrib><description>Objective An increasing proportion of patients with stage I non-small cell lung cancer (NSCLC) is undergoing sublobar resection (L−). However, there is little information about the risks and correlates of local recurrence (LR) after such surgery, especially compared with patients undergoing lobectomy (L+). Methods Ninety-three and 318 consecutive patients with stage I NSCLC underwent L− and L+, respectively, from 2000 to 2006. Median follow-up was 34 months. Results In the L− group, the LR rates at 2, 3, and 5 years were 13%, 24%, and 40%, respectively. The risk of LR was significantly associated with tumor grade, tumor size, and T stage. The crude risk of LR was 33.8% (21 of 62) for patients whose tumors were grade ≥ 2. In the L+ group, the LR rates at 2, 3, and 5 years were 14%, 19%, and 24%, respectively. The risk of LR significantly increased with increasing tumor size, length of hospital stay, and the presence of diabetes. The L− group experienced a significant increase in failure in the bronchial stump/staple line compared with the L+ group (10% vs 3%; P = .04) and nonsignificant trends toward increased ipsilateral hilar and subcarinal failure rates. Conclusions Patients with stage I NSCLC who undergo L− have an increased risk of LR compared with patients undergoing L+, particularly when they have tumors grade ≥ 2 or tumor size > 2 cm. If L− is considered, additional local therapy should be considered to reduce this risk of LR, especially with tumors grade ≥ 2 or size > 2 cm.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.12-0710</identifier><identifier>PMID: 23715196</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Age Factors ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung - diagnosis ; Carcinoma, Non-Small-Cell Lung - pathology ; Carcinoma, Non-Small-Cell Lung - surgery ; Continental Population Groups ; Diabetes Complications - complications ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Lung Neoplasms - diagnosis ; Lung Neoplasms - pathology ; Lung Neoplasms - surgery ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local - diagnosis ; Neoplasm Recurrence, Local - epidemiology ; Neoplasm Recurrence, Local - mortality ; Neoplasm Staging ; Pneumonectomy - methods ; Pulmonary/Respiratory ; Retrospective Studies ; Risk Factors ; Survival Rate ; Treatment Outcome</subject><ispartof>Chest, 2013-05, Vol.143 (5), p.1365-1377</ispartof><rights>The American College of Chest Physicians</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-58c809ca6362cd4d203e6add42b99e3e4886f16d1b03ff9445aaec84add567c3</citedby><cites>FETCH-LOGICAL-c414t-58c809ca6362cd4d203e6add42b99e3e4886f16d1b03ff9445aaec84add567c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23715196$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Varlotto, John M., MD</creatorcontrib><creatorcontrib>Medford-Davis, Laura N., MD</creatorcontrib><creatorcontrib>Recht, Abram, MD</creatorcontrib><creatorcontrib>Flickinger, John, MD</creatorcontrib><creatorcontrib>Yao, Nengliang, PhD</creatorcontrib><creatorcontrib>Hess, Clayton, MD</creatorcontrib><creatorcontrib>Reed, Michael F., MD, FCCP</creatorcontrib><creatorcontrib>Toth, Jennifer, MD</creatorcontrib><creatorcontrib>Zander, Dani S., MD, FCCP</creatorcontrib><creatorcontrib>DeCamp, Malcolm M., MD, FCCP</creatorcontrib><title>Identification of Stage I Non-small Cell Lung Cancer Patients at High Risk for Local Recurrence Following Sublobar Resection</title><title>Chest</title><addtitle>Chest</addtitle><description>Objective An increasing proportion of patients with stage I non-small cell lung cancer (NSCLC) is undergoing sublobar resection (L−). However, there is little information about the risks and correlates of local recurrence (LR) after such surgery, especially compared with patients undergoing lobectomy (L+). Methods Ninety-three and 318 consecutive patients with stage I NSCLC underwent L− and L+, respectively, from 2000 to 2006. Median follow-up was 34 months. Results In the L− group, the LR rates at 2, 3, and 5 years were 13%, 24%, and 40%, respectively. The risk of LR was significantly associated with tumor grade, tumor size, and T stage. The crude risk of LR was 33.8% (21 of 62) for patients whose tumors were grade ≥ 2. In the L+ group, the LR rates at 2, 3, and 5 years were 14%, 19%, and 24%, respectively. The risk of LR significantly increased with increasing tumor size, length of hospital stay, and the presence of diabetes. The L− group experienced a significant increase in failure in the bronchial stump/staple line compared with the L+ group (10% vs 3%; P = .04) and nonsignificant trends toward increased ipsilateral hilar and subcarinal failure rates. Conclusions Patients with stage I NSCLC who undergo L− have an increased risk of LR compared with patients undergoing L+, particularly when they have tumors grade ≥ 2 or tumor size > 2 cm. If L− is considered, additional local therapy should be considered to reduce this risk of LR, especially with tumors grade ≥ 2 or size > 2 cm.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carcinoma, Non-Small-Cell Lung - diagnosis</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Carcinoma, Non-Small-Cell Lung - surgery</subject><subject>Continental Population Groups</subject><subject>Diabetes Complications - complications</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Lung Neoplasms - diagnosis</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Recurrence, Local - diagnosis</subject><subject>Neoplasm Recurrence, Local - epidemiology</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Staging</subject><subject>Pneumonectomy - methods</subject><subject>Pulmonary/Respiratory</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kb1v2zAQxYkiReO4HbsWHLMoIUWKlpYCgRE3Boy2sL0TFHWy6dCiS0opAvSPzylOOvD7d4947wj5ytkNF7Py1u4h9Tc8z9iMsw9kwivBM1FIcUEmjOG9UFV-Sa5SOjA880p9Ipe5mPECtxPyb9lA17vWWdO70NHQ0k1vdkCX9GfosnQ03tM54LQauh2dm85CpL8RxrJETU8f3G5P1y490jZEugrWeLoGO8QIyNJF8D78dVi7GWofahPxNYEdf_tMPrbGJ_jytk7JdnG_nT9kq18_lvO7VWYll31WlLZklTVKqNw2ssmZAGWaRuZ1VYEAWZaq5arhNRNtW0lZGAO2lIgUambFlFyfZU8x_BkwLn10yaIn00EYkuaiUFUhC5kjmp1RG0NKEVp9iu5o4rPmTI9569e8Nc_1mDfy396kh_oIzX_6PWAEvp8BQH9PDqK23nWYtn-EZ0iHMMQOrWuuE0rqzdiysWNcKCbG8QLLfZHS</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Varlotto, John M., MD</creator><creator>Medford-Davis, Laura N., MD</creator><creator>Recht, Abram, MD</creator><creator>Flickinger, John, MD</creator><creator>Yao, Nengliang, PhD</creator><creator>Hess, Clayton, MD</creator><creator>Reed, Michael F., MD, FCCP</creator><creator>Toth, Jennifer, MD</creator><creator>Zander, Dani S., MD, FCCP</creator><creator>DeCamp, Malcolm M., MD, FCCP</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130501</creationdate><title>Identification of Stage I Non-small Cell Lung Cancer Patients at High Risk for Local Recurrence Following Sublobar Resection</title><author>Varlotto, John M., MD ; Medford-Davis, Laura N., MD ; Recht, Abram, MD ; Flickinger, John, MD ; Yao, Nengliang, PhD ; Hess, Clayton, MD ; Reed, Michael F., MD, FCCP ; Toth, Jennifer, MD ; Zander, Dani S., MD, FCCP ; DeCamp, Malcolm M., MD, FCCP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-58c809ca6362cd4d203e6add42b99e3e4886f16d1b03ff9445aaec84add567c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carcinoma, Non-Small-Cell Lung - diagnosis</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>Carcinoma, Non-Small-Cell Lung - surgery</topic><topic>Continental Population Groups</topic><topic>Diabetes Complications - complications</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Lung Neoplasms - diagnosis</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Recurrence, Local - diagnosis</topic><topic>Neoplasm Recurrence, Local - epidemiology</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Staging</topic><topic>Pneumonectomy - methods</topic><topic>Pulmonary/Respiratory</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Varlotto, John M., MD</creatorcontrib><creatorcontrib>Medford-Davis, Laura N., MD</creatorcontrib><creatorcontrib>Recht, Abram, MD</creatorcontrib><creatorcontrib>Flickinger, John, MD</creatorcontrib><creatorcontrib>Yao, Nengliang, PhD</creatorcontrib><creatorcontrib>Hess, Clayton, MD</creatorcontrib><creatorcontrib>Reed, Michael F., MD, FCCP</creatorcontrib><creatorcontrib>Toth, Jennifer, MD</creatorcontrib><creatorcontrib>Zander, Dani S., MD, FCCP</creatorcontrib><creatorcontrib>DeCamp, Malcolm M., MD, FCCP</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Varlotto, John M., MD</au><au>Medford-Davis, Laura N., MD</au><au>Recht, Abram, MD</au><au>Flickinger, John, MD</au><au>Yao, Nengliang, PhD</au><au>Hess, Clayton, MD</au><au>Reed, Michael F., MD, FCCP</au><au>Toth, Jennifer, MD</au><au>Zander, Dani S., MD, FCCP</au><au>DeCamp, Malcolm M., MD, FCCP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification of Stage I Non-small Cell Lung Cancer Patients at High Risk for Local Recurrence Following Sublobar Resection</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>2013-05-01</date><risdate>2013</risdate><volume>143</volume><issue>5</issue><spage>1365</spage><epage>1377</epage><pages>1365-1377</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><abstract>Objective An increasing proportion of patients with stage I non-small cell lung cancer (NSCLC) is undergoing sublobar resection (L−). However, there is little information about the risks and correlates of local recurrence (LR) after such surgery, especially compared with patients undergoing lobectomy (L+). Methods Ninety-three and 318 consecutive patients with stage I NSCLC underwent L− and L+, respectively, from 2000 to 2006. Median follow-up was 34 months. Results In the L− group, the LR rates at 2, 3, and 5 years were 13%, 24%, and 40%, respectively. The risk of LR was significantly associated with tumor grade, tumor size, and T stage. The crude risk of LR was 33.8% (21 of 62) for patients whose tumors were grade ≥ 2. In the L+ group, the LR rates at 2, 3, and 5 years were 14%, 19%, and 24%, respectively. The risk of LR significantly increased with increasing tumor size, length of hospital stay, and the presence of diabetes. The L− group experienced a significant increase in failure in the bronchial stump/staple line compared with the L+ group (10% vs 3%; P = .04) and nonsignificant trends toward increased ipsilateral hilar and subcarinal failure rates. Conclusions Patients with stage I NSCLC who undergo L− have an increased risk of LR compared with patients undergoing L+, particularly when they have tumors grade ≥ 2 or tumor size > 2 cm. If L− is considered, additional local therapy should be considered to reduce this risk of LR, especially with tumors grade ≥ 2 or size > 2 cm.</abstract><cop>United States</cop><pmid>23715196</pmid><doi>10.1378/chest.12-0710</doi><tpages>13</tpages></addata></record> |
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| subjects | Adult Age Factors Aged Aged, 80 and over Carcinoma, Non-Small-Cell Lung - diagnosis Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - surgery Continental Population Groups Diabetes Complications - complications Female Follow-Up Studies Humans Length of Stay Lung Neoplasms - diagnosis Lung Neoplasms - pathology Lung Neoplasms - surgery Male Middle Aged Multivariate Analysis Neoplasm Recurrence, Local - diagnosis Neoplasm Recurrence, Local - epidemiology Neoplasm Recurrence, Local - mortality Neoplasm Staging Pneumonectomy - methods Pulmonary/Respiratory Retrospective Studies Risk Factors Survival Rate Treatment Outcome |
| title | Identification of Stage I Non-small Cell Lung Cancer Patients at High Risk for Local Recurrence Following Sublobar Resection |
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