Resident Physician University of Pittsburgh/UPMC Pittsburgh, Pennsylvania, United States
Disclosure(s):
Chigozirim N. Ekeke, MD: No financial relationships to disclose
Purpose: Five-year survival for operable stage I disease is greater than 70%. However, there's limited evidence of which risk factors contribute to distant metastasis within 1-year of resection. Our study compares perioperative outcomes in patients with operable stage I NSCLC that developed early distant-recurrence and non-recurrent patients following resection. Methods: 3958 patients underwent lung resection for stage-I lung cancer over a 19-year period, were identified from a prospectively organized database. Inclusion criteria were patients with pathologically proven distant metastasis within 12 months of surgery (“Blast metastasis”). Patients with loco-regional recurrence, wedge resection or pneumonectomy, neoadjuvant treatment, SCLC, carcinoid tumors, distant recurrence greater than one year after surgery, and patients with M1a disease were excluded. Baseline variables comprising the logistic regression model included: body mass index (BMI), tumor size, Charlson Comorbidity Index (CCI), gender, SUV, ASA, and surgical approach. A 1:2 propensity match (blast mets: non-blast mets) for multiple clinical covariates was performed to identify the final study cohort. Perioperative outcomes were compared between the two groups using a univariate analysis, which was later confirmed with a multivariate analysis. Overall survival was defined using Kaplan-Meier analysis. Results: 67 patients developed distant metastasis (only) within 1-year. For the propensity match, we chose 195 patients who did not recur for at least 5 years following surgical treatment for stage I NSCLC. After propensity matching, 54 patients had evidence of distant recurrence and 90 patients had no distant recurrence. Angiolymphatic invasion (p = 0.0008) and histology type (p=0.02) were statistically significant factors for determining likelihood of distant recurrence versus non recurrence, based on multivariate analysis. The “other histology” group (n=11) was composed mostly of invasive pleomorphic carcinoma (n=6). Median survival of the recurrent cohort and non-recurrent cohorts were 15.9 months and 88.7 months, respectively, and improved overall survival was shown in the nonrecurrence group (p=0.0001). Conclusion: The Blast metastasis group had worse survivability in comparison to the patients without metastasis. Angiolymphatic invasion and histology type were the variables that predicted likelihood of distant recurrence within 1-year of surgical treatment for stage I NSCLC.
Identify the source of the funding for this research project: The project described was supported by the Department of Cardiothoracic Surgery at UPMC and the National Institutes of Health through Grant Number UL1TR001857.
