Effect of Follow-Up Surveillance After Curative-Intent Treatment of NSCLC on Detection of New and Recurrent Disease, Retreatment, and Survival: A Systematic Review and Meta-Analysis

J Thorac Oncol. 2021 May;16(5):784-797. doi: 10.1016/j.jtho.2021.01.1622. Epub 2021 Feb 12.


Introduction: Patients with NSCLC may be treated with curative intent, yet they remain at high risk of both disease recurrence and second primary lung cancer (SPLC) and increased risk of early death. Guidelines provide recommendations for follow-up, but there is little consensus, and review of available evidence is necessary. The use of a systematic follow-up strategy for the detection of disease recurrence or SPLC after curative-intent treatment of NSCLC may increase the proportion of patients available for retreatment and increase the survival of patients with surveillance detection.

Methods: We performed a systematic review and meta-analysis of prospective studies on follow-up of NSCLC after curative-intent treatment to answer the following three questions: What is the effect of follow-up on detection of recurrence or SPLC? What is the effect of surveillance detection on curative-intent retreatment? What is the survival impact?

Results: Recurrence or SPLC was observed in 17.8% to 71% of patients. Scheduled imaging-detected recurrence in 60% to 100% of cases, yet neither computed tomography-based (OR = 2.31, 95% confidence interval [CI]: 0.27-19.49, p = 0.44) nor positron emission tomography-computed tomography-based follow-up (OR = 1.431, 95% CI: 0.92-2.22, p = 0.12) was statistically superior to standard follow-up strategies. Detection of disease recurrence/SPLC significantly increased the odds of curative-intent retreatment (OR = 4.31; 95% CI: 2.10-8.84, p < 0.0001). Curative-intent retreatment prolonged survival in reported studies.

Conclusions: The early detection of disease recurrence/SPLC may increase the likelihood of curative-intent retreatment and prolong survival. There is a clear need for prospective randomized controlled studies of follow-up to confirm effectiveness of available follow-up modalities.

Keywords: Follow-up; Non–small cell lung cancer; Retreatment; Surveillance; Survival.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Follow-Up Studies
  • Humans
  • Lung Neoplasms* / diagnosis
  • Lung Neoplasms* / therapy
  • Neoplasm Recurrence, Local / diagnosis
  • Prospective Studies
  • Retreatment