Lee Kanghoon, Kim Hyeong Ryul, Kim Dong Kwan, Kim Yong-Hee, Park Seung-Ill, Choi Se Hoon, Han Junhee
1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
2 Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Asian Cardiovasc Thorac Ann. 2017 Nov;25(9):623-629. doi: 10.1177/0218492317737641. Epub 2017 Oct 23.
Background The aim of this retrospective study was to review recurrence patterns of stage I non-small-cell lung cancer and identify prognostic factors for post-recurrence survival. Methods Among 940 patients with pathological stage I non-small-cell lung cancer who underwent curative resection, 261 experienced a recurrence; of these, 188 had adenocarcinoma and 62 had squamous cell carcinoma. Oligo-recurrence was defined as 1-3 recurrent lesions restricted to a single organ. Potentially curative local treatment included surgery, stereotactic radiotherapy, and photodynamic therapy. Results The median follow-up duration was 65 months (range 4-186 months). The most common site of recurrence was the lung in 145 patients, followed by mediastinal lymph nodes in 49, pleura in 30, and brain in 27. Local treatment for recurrent tumors included surgery in 59 patients, stereotactic radiotherapy in 46, photodynamic therapy in 2, and other radiotherapy in 41. Seventy-eight patients received chemotherapy only, and 35 received conservative treatment. Among 125 patients who were evaluated for an epidermal growth factor receptor gene mutation, 31 were treated with epidermal growth factor receptor-tyrosine kinase inhibitor. The 3- and 5-year post-recurrence survival rates were 49.1% and 33.8%, respectively. Age at recurrence, adenocarcinoma cell type, disease-free interval, epidermal growth factor receptor-tyrosine kinase inhibitor treatment, and potentially curative local treatment were independent prognostic factors for survival in multivariate analysis. Conclusions Local treatment for recurrence should be considered in selected candidates, and use of epidermal growth factor receptor-tyrosine kinase inhibitor I is reasonable if an epidermal growth factor receptor mutation is detected.
背景 这项回顾性研究的目的是回顾I期非小细胞肺癌的复发模式，并确定复发后生存的预后因素。方法 在940例行根治性切除的病理I期非小细胞肺癌患者中，261例出现复发；其中，188例为腺癌，62例为鳞状细胞癌。寡复发定义为1 - 3个复发灶局限于单个器官。潜在可治愈的局部治疗包括手术、立体定向放射治疗和光动力治疗。结果 中位随访时间为65个月（范围4 - 186个月）。最常见的复发部位是肺，有145例患者，其次是纵隔淋巴结49例，胸膜30例，脑27例。复发性肿瘤的局部治疗包括59例手术、46例立体定向放射治疗、2例光动力治疗和41例其他放射治疗。78例患者仅接受化疗，35例接受保守治疗。在125例接受表皮生长因子受体基因突变评估的患者中，31例接受了表皮生长因子受体 - 酪氨酸激酶抑制剂治疗。复发后3年和5年生存率分别为49.1%和33.8%。复发时年龄、腺癌细胞类型、无病间期、表皮生长因子受体 - 酪氨酸激酶抑制剂治疗以及潜在可治愈的局部治疗在多变量分析中是生存的独立预后因素。结论 对于选定的患者应考虑对复发进行局部治疗，如果检测到表皮生长因子受体突变，使用表皮生长因子受体 - 酪氨酸激酶抑制剂I是合理的。
