Evaluating the predictors of early recurrence in patients with stage IIIA-N2 non-small cell lung cancer after surgery.

This study evaluated the predictors of early recurrence in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC) after surgery. The data showed that early recurrence after surgery was associated with poor survival outcomes in patients with stage IIIA-N2 NSCLC. Smoking history, large tumor size, increased lymph node ratio, and increased platelet-to-lymphocyte ratio were predictors of early recurrence in these patients.

NSCLC is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. In patients with stage III-N2 NSCLC, the cancer has spread from the lungs to the nearby lymph nodes in the chest. The main treatment for patients with resectable (operable) stage III-N2 NSCLC is surgery.

Treatment of stage III-N2 NSCLC after surgery remains a challenge. The long-term survival rates are also not high as many patients experience early recurrence (coming back of cancer) after surgery. Some studies have found that clinical (age, smoking status), pathological (tumor size), and inflammatory factors can be effective predictors of survival in patients with NSCLC. However, there are very few studies evaluating what are the risk factors for early recurrence in patients with stage IIIA-N2 NSCLC after surgery.

This study involved 238 patients with stage IIIA-N2 NSCLC who underwent surgery. Group 1 included 69 patients who experienced an early recurrence within 1 year after surgery. Group 2 included 169 patients who had recurrence more than 1 year after surgery or did not have recurrence at all. The average follow-up time was 43.5 months.

The average overall survival was significantly lower (20.6 months) for group 1 compared to group 2 (83.1 months). After 3 years, 31.9% of patients in group 1 were alive compared to 78% of the patients in group 2. After 5 years, 16.1% of patients in group 1 were alive compared to 62.5% of the patients in group 2. The average survival without recurrence was also significantly lower for group 1 (6.93 months) compared to group 2 (36.6 months).  

Patients with a history of smoking, those with larger tumor sizes (larger than 2.95 cm), those with more lymph nodes affected, and higher platelet-to-lymphocyte ratio (PLR; 139 or higher) were all associated with early recurrence. Patients with early recurrence were more likely to develop bone metastases.

This study concluded that early recurrence after surgery was associated with poor survival outcomes in patients with stage IIIA-N2 NSCLC. Smoking history, large tumor size, increased lymph node ratio, and increased platelet-to-lymphocyte ratio were predictors of early recurrence in these patients.

This study looked back in time at medical records. The sample size was very small and the follow-up time after surgery was too short. Also, this study was conducted only in a single institution in China.