Post-recurrence survival of patients with non-small-cell lung cancer after curative resection with or without induction/adjuvant chemotherapy

Abstract

Objectives: Recently, the prognosis of patients with non-small-cell lung cancer (NSCLC) has improved, thanks to the standardization of adjuvant chemotherapy and the introduction of molecular-targeted drugs, notably epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors and other new anti-cancer agents. However, the survival characteristics and prognosis of patients with recurrent NSCLC after curative resection are not well understood.

Methods: Of the 430 consecutive patients with NSCLC who underwent complete surgical resection at our institution between January 2004 and July 2011, we included 76 patients with recurrence whose post-recurrence treatment and outcome could be confirmed. We then retrospectively evaluated the effect of prognostic factors on post-recurrence survival.

Results: There were 50 men and 26 women, and the median age at recurrence was 74.5 years. The median time from surgical resection to recurrence was 12.7 months. Thirty-eight of the 76 (50%) patients underwent multimodality treatment with surgery and preoperative and/or postoperative chemotherapy as their initial treatment. For recurrence, systemic chemotherapy was administered to 64 (84%) patients, and the disease control rate for first-line chemotherapy was 55%. The 1- and 2-year post-recurrence survival rates were 68.3 and 45.8%, respectively, and the median post-recurrence survival time was 17.7 months. Six independent prognostic factors were identified: wild-type EGFR, no adjuvant chemotherapy for the primary lung cancer, age ≥ 80 years at recurrence, a poor Eastern Cooperative Oncology Group performance status at recurrence, symptomatic at recurrence and no systemic chemotherapy for recurrence, which significantly decreased the post-recurrence survival.

Conclusions: The prognosis of patients with NSCLC recurrence after surgery is currently improving. Our results suggested two new prognostic factors, adjuvant chemotherapy and EGFR mutations, neither of which have been previously reported. Treatment strategies for postoperative recurrence should be established based on a more detailed subdivision of factors, such as histology and molecular markers, in the future.

Figures

Figure 1:

Survival curve illustrating the post-recurrence survival of 76 patients.

Figure 2:

Survival curves illustrating the post-recurrence survival of 35 patients who initially underwent surgery followed by adjuvant chemotherapy and 41 patients who underwent surgery alone. The curves differed significantly for the patients treated with surgery followed by adjuvant chemotherapy vs the patients treated with surgery alone (P = 0.0021).

Figure 3:

Survival curves illustrating the post-recurrence survival of 22 patients who received platinum-based induction or adjuvant chemotherapy, 16 who received adjuvant chemotherapy with uracil-tegafur and 38 who did not receive pre- or postoperative chemotherapy. The curves differed significantly for patients who received adjuvant chemotherapy with uracil-tegafur vs those who received no perioperative chemotherapy (P = 0.0089). However, the curves did not differ significantly for patients who received pre- or postoperative platinum-based chemotherapy vs patients who received no perioperative chemotherapy (P = 0.1031) or for patients who received adjuvant chemotherapy with uracil-tegafur compared with those who received pre- or postoperative platinum-based chemotherapy (P = 0.4231).