Pathological Pleural Invasion is a Risk Factor for Late Recurrence in Long-Term Survivors of Non-small Cell Lung Cancer after Complete Resection

Ryu Kanzaki; Hiroyuki Fukuda; Masao Kobayashi; Julian Horiguchi; Sachi Kawagishi; Tomohiro Maniwa; Makoto Fujii; Jiro Okami

doi:10.1245/s10434-024-15279-9

Pathological Pleural Invasion is a Risk Factor for Late Recurrence in Long-Term Survivors of Non-small Cell Lung Cancer after Complete Resection

Ann Surg Oncol. 2024 Apr 22. doi: 10.1245/s10434-024-15279-9. Online ahead of print.

Authors

Ryu Kanzaki¹, Hiroyuki Fukuda², Masao Kobayashi², Julian Horiguchi², Sachi Kawagishi², Tomohiro Maniwa², Makoto Fujii³, Jiro Okami²

Affiliations

¹ Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan. rkanzaki@tj8.so-net.ne.jp.
² Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
³ Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan.

PMID: 38647914
DOI: 10.1245/s10434-024-15279-9

Abstract

Background: Information regarding late recurrence after pulmonary resection for non-small cell lung cancer (NSCLC) is limited. This study aimed to analyze the risk factors for late recurrence after surgery for NSCLC in the current era.

Patients and methods: We conducted a retrospective study of patients who underwent complete resection for pathological I-III NSCLC between 2006 and 2015. Late recurrence was defined as a recurrence that met the following conditions: (1) the patient underwent chest computed tomography (CT) at or after 54 months after surgery and recurrence was not detected at that time, and (2) recurrence that occurred more than 5 years after surgery. The factors influencing late recurrence, relapse-free survival (RFS), and overall survival (OS) after surgery were analyzed.

Results: A total of 1275 with 5-year relapse-free survival after surgery were enrolled in this study. The mean age of the patients was 66.4 years and 54% of the patients were men. The median interval between surgery and the latest follow-up examination was 98 months. In total, 35 patients (2.7%) experienced late recurrence and 138 patients have died thus far. The cumulative recurrence, RFS, and OS rates at 10 years were 3.9%, 84.9%, and 86.3%, respectively. A multivariate analysis revealed that pleural invasion was an independent risk factor for late recurrence. Pleural invasion was a poor prognostic factor for both RFS and OS.

Conclusions: Pleural invasion was a predictor of late recurrence. Age > 67 years, preoperative serum carcinoembryonic antigen (CEA) > 5 ng/ml, non-adenocarcinoma, and pleural invasion were poor prognostic factors for RFS.