Changes over time in the risk of recurrent NSCLC after surgery

This study examined the risk of recurrence following early-stage non-small cell lung cancer (NSCLC) treated with surgery. The authors showed that the risk of relapse after surgery changes in a predictable way over time, where the first two years after surgery has the highest risk of relapse. They noted that the risk then declines but starts to rise again after 8 years.

Advances in screening techniques means that non-small-cell lung cancer (NSCLC) cases are detected at earlier stages. The first line of treatment for early-stage NSCLC is surgical removal, but there is a high risk of relapse. While several studies have shown the risk of relapse, there is very limited data on how this risk value changes over time following surgery. Knowing how the risk of relapse changes over time could help to identify patient subgroups that would benefit from chemotherapy following surgery.

This study included 994 patients with surgically removed NSCLC. Patients were followed for an average of 6.1 years.

Overall, 256 patients had recurring cancer and 162 patients died due to cancer before the final follow-up. Of the cases of recurring cancer, 87.5% of patients had distant recurrence (the cancer relapsed in an area away from where it began). The most common areas of distant relapse were other areas of the lung and the bones.

Average recurrence free survival (time from surgery to cancer relapse) was 8.8 years. The risk of relapse was greatest 1.6 years after surgery. This risk rate than declined, then peaked again at 8.8 years.

Patients who smoked had relapses sooner after surgery, where the highest risk of relapse was 1.2 years compared to 3.2 years for than those who did not. In addition, patients who smoked had a higher risk of later relapse after 7.5 years.

The authors concluded that the risk of relapse was predictable over time for patients with early-stage NSCLC. The authors suggested that these patterns could help in planning treatment options.

Not enough patients in this study received adjuvant therapy, therefore the authors were not able to determine a patient subgroup who would more likely benefit from this therapy.