Dittberner F A, Borg M H, Larsen K R, Saghir Z, Guldbrandsen K F, Rasmussen T R
Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
Department of Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark.
Eur Clin Respir J. 2025 Sep 13;12(1):2560133. doi: 10.1080/20018525.2025.2560133. eCollection 2025.
Non-small lung cancer (NSCLC) carries a substantial risk for recurrence even after complete resection. Evidence regarding the survival impact of post-resection surveillance strategies remains limited. Danish guidelines for lung cancer recommend contrast-enhanced computed tomography (CE-CT) every 3 months for the first 2 years and every 6 months for the subsequent 3 years, a frequency twice that of major international guidelines. This study retrospectively assessed the outcomes of this high-frequency CT surveillance in Denmark, specifically focusing on recurrence detection within two years post-surgery, the potential for renewed curative-intent treatment, and post-recurrence prognosis during this initial period.
A cohort of 1079 patients who underwent resection for NSCLC in the period 2019-2020 was identified from the Danish Lung Cancer Registry (DLCR). Detailed information regarding new diagnoses of lung cancer, offered treatments, and mortality was extracted from patients' medical records.
Within two years following resection, 20% of patients developed a new diagnosis of lung cancer. Of these, 28.5% presented with localized disease (stage I-II), 26% with locally advanced disease (stage III), and 45% with metastatic disease. Recurrence frequencies ranged from 13% for pathological stage I (pStage I) to 44.5% for pStage III. Forty-eight percent of patients were offered renewed curative-intent treatment, demonstrating a 2-year post-recurrence survival of 78%. In contrast, patients offered palliative care or no treatment had a 2-year post-recurrence survival of 40%.
The proportion of recurrences presenting with metastatic disease was lower than reported in cohort studies with less frequent surveillance. A further notable finding was the high proportion of patients offered curative-intent treatment for recurrent disease, exceeding previously reported rates. These patients demonstrated a 2 year post-recurrence survival comparable to that observed following a primary NSCLC diagnosis. The presence of symptoms at the time of recurrence was a negative prognostic indicator, even among patients receiving palliative treatment.
非小细胞肺癌（NSCLC）即使在完全切除后仍有很高的复发风险。关于切除术后监测策略对生存影响的证据仍然有限。丹麦肺癌指南建议在术后前两年每3个月进行一次对比增强计算机断层扫描（CE-CT），随后3年每6个月进行一次，这一频率是主要国际指南的两倍。本研究回顾性评估了丹麦这种高频CT监测的结果，特别关注术后两年内的复发检测、再次进行根治性治疗的可能性以及这一初始阶段复发后的预后。
从丹麦肺癌登记处（DLCR）中确定了一组在2019年至2020年期间接受NSCLC切除术的1079例患者。从患者的病历中提取了有关肺癌新诊断、所提供的治疗以及死亡率的详细信息。
在切除术后两年内，20%的患者被新诊断出患有肺癌。其中，28.5%为局限性疾病（I-II期），26%为局部晚期疾病（III期），45%为转移性疾病。复发频率从病理I期（pStage I）的13%到pStage III的44.5%不等。48%的患者接受了再次根治性治疗，其复发后2年生存率为78%。相比之下，接受姑息治疗或未接受治疗的患者复发后2年生存率为40%。
出现转移性疾病的复发比例低于监测频率较低的队列研究报告的比例。另一个值得注意的发现是，接受复发性疾病根治性治疗的患者比例很高，超过了先前报告的比例。这些患者复发后2年生存率与原发性NSCLC诊断后的生存率相当。复发时出现症状是一个不良预后指标，即使在接受姑息治疗的患者中也是如此。
