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Clinical Features and Prognostic Factor of Thoracic Postoperative Oligo-Recurrence of Non-Small-Cell Lung Cancer

Authors Yuan Q, Wang W, Zhang Q, Wang Y, Chi C, Xu C

Received 10 September 2019

Accepted for publication 17 February 2020

Published 25 February 2020 Volume 2020:12 Pages 1397—1403


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Dr Sanjeev Srivastava

Qi Yuan, 1–3 Wei Wang, 1–3 Qian Zhang, 1–3 Yuchao Wang, 1–3 Chuanzhen Chi, 1–3 Chunhua Xu 1–3

1Endoscopic Center of the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, People’s Republic of China; 2Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, Jiangsu 210029, People’s Republic of China; 3Department of Respiratory Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, People’s Republic of China

Correspondence: Chunhua Xu
Department of Respiratory Medicine, The Affiliated Brain Hospital of Nanjing Medical University, 215 Guangzhou Road, Nanjing 210029, People’s Republic of China

Objective: The study aimed to clarify clinical features and prognostic factors of thoracic oligo-postoperative recurrences that underwent local therapy of non-small-cell lung cancer (NSCLC).
Methods: From 2332 patients of resected pathological stage I–IIIA NSCLC between 2008 and 2015, a total of 542 patients in follow developed recurrence. Thoracic oligo-recurrence was defined as 1– 3 loco-regional confined to lung lobe, hilar/mediastinal lymph nodes, bronchial stump, or chest wall. This study included 56 thoracic oligo-recurrences. Local therapy included secondary surgery, stereotactic radiotherapy, radiotherapy with a 45 Gy or higher dose, and proton radiation therapy, performed with radical intent. We retrospectively reviewed the postoperative data and performed the univariate and multivariate analysis by Kaplan-Meier methods and Cox regression models, respectively.
Results: Thoracic Oligo-recurrence was identified in 56(542,10.3%) patients, mainly in lung lobe(n=22,39%) and regional lymph nodes(n=19,34%). Compared with distant oligo-recurrences, more of the thoracic oligo-recurrences were II–III in pathological stage at initial surgery(p=0.002) and less were adenocarcinoma(p=0.005). The 5-year postoperative survival rate and postoperative progression-free survival rate of thoracic oligo-recurrence were 10.8% and 6.7%, respectively. Median post-recurrence survival (PRS) was 31 months, and the median postoperative progression-free survival (PR-PFS) was 17 months. Multivariate analyses revealed that time to recurrence ≥ 12 months was associated with improved PRS [odds ratio (OR) 0.74, confidence interval (CI) 0.65– 0.85], and regional lymph node oligo-recurrence was associated with poor PRS [OR 1.48, CI 1.38– 1.60]. All the five long-term (≥ 5-year) progression-free survivors were with a solitary pulmonary recurrence.
Conclusion: Thoracic postoperative oligo-recurrence of non-small-cell lung cancer is a limited but highly heterogeneous population, with different prognosis at different recurrence sites. Local therapy for thoracic oligo-recurrence of NSCLC achieved favourable PRS in a selected population. Pulmonary solitary oligo-recurrence may achieve a long survival time.

Keywords: oligo-recurrence, NSCLC, postoperative recurrence, local therapy

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