Hung J-J, Hsu W-H, Hsieh C-C, Huang B-S, Huang M-H, Liu J-S, Wu Y-C
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Thorax. 2009 Mar;64(3):192-6. doi: 10.1136/thx.2007.094912.
Resection is the best treatment for patients with stage I non-small cell lung cancer (NSCLC). Patterns of disease recurrence after complete resection in stage I NSCLC have not been well demonstrated. The aim of this study was to evaluate the prognostic predictors of post-recurrence survival in patients with resected stage I NSCLC with local recurrence.
The clinicopathological characteristics of 123 patients with local recurrence after complete resection of stage I NSCLC in Taipei Veterans General Hospital between 1980 and 2000 were retrospectively reviewed. Post-recurrence survival and their predictors were analysed.
The patterns of local recurrence included local only in 74 (60.2%) and both local and distant in 49 (39.8%) patients. The 1 and 2 year post-recurrence survival rates for the 74 patients with local only recurrence were 48.7% and 17.6%, respectively. Tumour size (p = 0.033) and treatment for initial recurrence (p<0.001) were significant predictors for post-recurrence survival in 74 patients with local only recurrence in univariate analyses. The hazard of death was greater in patients with larger tumour size. Treatment for initial recurrence (p = 0.001) was still a significant prognostic indicator in multivariate analyses. Patients who underwent reoperation after local recurrence survived longer than those who received chemotherapy and/or radiotherapy and those that received no treatment.
Treatment for initial recurrence is a prognostic predictor for post-recurrence survival in resected stage I NSCLC with local recurrence. Complete surgical resection should be considered in selected candidates with resectable local recurrent disease.
手术切除是Ⅰ期非小细胞肺癌（NSCLC）患者的最佳治疗方法。Ⅰ期NSCLC完全切除术后疾病复发模式尚未得到充分证实。本研究旨在评估Ⅰ期NSCLC局部复发患者复发后生存的预后预测因素。
回顾性分析1980年至2000年台北荣民总医院123例Ⅰ期NSCLC完全切除术后局部复发患者的临床病理特征。分析复发后生存率及其预测因素。
局部复发模式包括仅局部复发74例（60.2%）和局部及远处均复发49例（39.8%）。74例仅局部复发患者的1年和2年复发后生存率分别为48.7%和17.6%。单因素分析显示，肿瘤大小（p = 0.033）和初始复发治疗（p<0.001）是74例仅局部复发患者复发后生存的重要预测因素。肿瘤体积较大患者的死亡风险更高。在多因素分析中，初始复发治疗（p = 0.001）仍然是一个重要的预后指标。局部复发后接受再次手术的患者比接受化疗和/或放疗以及未接受治疗的患者生存时间更长。
初始复发治疗是Ⅰ期NSCLC局部复发患者复发后生存的预后预测因素。对于可切除的局部复发病例，应考虑对选定的患者进行完整的手术切除。
