ArticleJournal of thoracic disease2025
Predictive factors for late recurrence beyond 5 years after curative resection of stage I non-small cell lung cancer: a risk scoring approach.
Article in Journal of thoracic disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Most recurrences of early-stage non-small cell lung cancer (NSCLC) occur within the first three years after surgery, and current follow-up guidelines typically focus on this early postoperative period. While several studies have reported risk factors for recurrence within five years, data on recurrence beyond five years are limited. This study aimed to clarify the clinicopathological features of patients with pathological stage I lung cancer who develop late recurrence, defined as recurrence occurring more than five years after surgery, and to propose optimal follow-up strategies for such patients. Methods: We retrospectively analyzed 186 patients with pathological stage I lung cancer who were followed for more than five years after surgery. Late recurrence was defined as recurrence occurring beyond five years postoperatively. Clinicopathological factors associated with late recurrence were evaluated. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cutoff values for continuous variables. A multivariate Cox proportional hazards model was employed to identify predictors of late recurrence, including age, sex, body mass index (BMI), smoking history, maximum standardized uptake value (SUVmax), carcinoembryonic antigen (CEA) level, consolidation-to-tumor ratio (C/T ratio), mean computed tomography (CT) attenuation value, tumor size, surgical procedure, histological type, pathological stage, and the presence of lymphatic, vascular, or pleural invasion. Results: Multivariate analysis identified age ≥69 years, preoperative CEA ≥2.8 ng/mL, and the presence of lymphatic invasion as independent predictors of recurrence beyond five years. Patients were stratified into four risk groups according to the number of these three factors present (0, 1, 2, or 3). The corresponding late recurrence rates were 0% for score 0, 2.7% for score 1, 26.9% for score 2, and 77.8% for score 3. Conclusions: Advanced age (≥69 years), elevated preoperative CEA (≥2.8 ng/mL), and lymphatic invasion are significant predictors of late recurrence in patients with stage I lung cancer. A simple risk score based on these factors may help identify patients who would benefit from extended follow-up beyond five years post-surgery.
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