Prognostic Impact of Recurrence Pattern for Surgically Resected Non-Small Cell Lung Cancer.

[INTRODUCTION] Although several prognostic risk factors have been identified for non-small cell lung cancer (NSCLC) patients who undergo pulmonary resection, the significance of several factors remains unclear, including the number and location of recurrent foci. Here, we investigated associations between clinicopathological characteristics and the risk of recurrence patterns.

[METHODS] We retrospectively evaluated the prognostic impact of the recurrence pattern and individual recurrence sites for 1,000 NSCLC patients who underwent pulmonary resection between 2002 and 2021. The recurrence was defined by imaging tools, and the data were analyzed using logistic regression and Cox proportional hazards regression models.

[RESULTS] Simultaneous intrathoracic and extra-thoracic recurrence was associated with significantly shorter overall survival compared with either recurrence pattern alone. Multivariate analyses identified significant risk factors for sites of recurrence as follows: age (p = 0.03), prognostic nutrition index (p = 0.03), lymphatic invasion (p = 0.03), pathological lymph node metastasis (pN)1 (p = 0.02), and pN2 (p < 0.01) for bone metastasis; cancer-inflammation prognostic index (CIPI) (p = 0.04), maximum standardized uptake value (SUV) (p < 0.01), and pN2 (p < 0.01) for brain metastasis; histological type without adenocarcinoma and squamous cell carcinoma (p < 0.01) for liver metastasis; age (p < 0.01), SUV (p < 0.01), lower lobe (p < 0.01), and pN2 (p < 0.01) for lung metastasis; CIPI (p < 0.01), SUV (p < 0.01), Ly (p = 0.01), pN1 (p < 0.01), and pN2 (p = 0.01) for lymph node metastasis; and CIPI (p < 0.01) for pleural dissemination.

[CONCLUSION] Simultaneous intrathoracic and extra-thoracic recurrence was a significant prognostic indicator of poor overall survival. Identification of the risk factors for each recurrence site may assist in planning optimal routine postoperative surveillance strategies.