Risk factors and survival associated with lung cancer recurrence after curative-intent surgery: beyond tnm staging

SESSION TITLE: What Is New in Cardiothoracic Surgery? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:55 pm - 01:44 pm PURPOSE: Lung cancer recurrence following curative-intent surgery remains a challenge for multi-disciplinary care teams and an important cause of mortality for patients. Recent years have seen increased interest in advancing minimally invasive surgery techniques and perioperative immunotherapy and targeted therapies to improve outcomes. Currently, TNM staging is the main determinant of long-term outcomes and candidacy for perioperative therapies. The purpose of this study was to identify risk factors beyond TNM staging associated with lung cancer recurrence as well as overall survival following recurrence. METHODS: A retrospective institutional database was used to identify patients who underwent surgery for Non-Small Cell Lung Cancer (NSCLC) and were identified as disease free in postoperative follow-up from 2005-2014. Patient characteristics, diagnostics, and operations were compared by recurrence of disease using X2 and ANOVA tests. Multivariable Cox proportional hazard models identified factors associated with disease recurrence and patient survival. Kaplan Meier analysis was performed to compare five-year overall survival rates in patients with and without disease recurrence. RESULTS: There were 1,197 patients identified who underwent surgical resection with 396 (33.1%) developing recurrence of lung cancer in follow-up. Patients who developed recurrence were older, smoked more frequently, had higher T-stage and N-stage tumors, and had higher rates of lymphovascular and visceral pleural invasion (p<0.016 for all). Modeled factors associated with recurrence included wedge resection (HR 1.36, p= 0.034), lymphovascular invasion (HR 1.55, p=0.013), and visceral pleural invasion (HR 1.43, p=0.008). Higher standardized uptake values (SUV) from preoperative PET scans were also associated with higher recurrence rates (p=0.0039). Overall five-year survival for patients without recurrence was 72.2% compared to 47.4% (p<0.001). Multivariable models showed minimally invasive modalities during the initial operation were associated with increased survival in patients who developed recurrence (HR 0.56, p=0.001) whereas squamous histology (HR 1.46, p=0.0350), bilobectomy (HR 3.26, p=0.0020) and sleeve lobectomy (HR 9.15, p=0.049) were associated with worse survival. CONCLUSIONS: Up to a third of patients experience recurrence after complete surgical resection of lung cancer. Recurrence is a common cause of increased mortality. PET SUV max, lymphovascular invasion, and visceral pleural invasion appear to be important risk factors associated with recurrence. In the case of PET SUV max, there appears to be a direct relationship between primary tumor metabolic activity and recurrence as well as overall survival. These factors add information beyond TNM staging, and may help prognosticate and potentially improve patient selection for emerging perioperative therapies or clinical trials. CLINICAL IMPLICATIONS: The risk factors identified in this study may help direct and tailor more aggressive treatment managements for patients with higher likelihood of cancer recurrence. The increasing role of minimally invasive surgery may improve long-term survival for patients who develop recurrent disease. DISCLOSURES: No relevant relationships by Shanda Blackmon Grant Recipient relationship with Medtronic Please note: 2019-present Added 03/29/2023 by Brandon Hendriksen, source=Web Response, value=Grant/Research Support No relevant relationships by Raffaele Rocco Consultant relationship with Atricure Inc Please note: 2022 Added 03/28/2023 by Luis Tapias, source=Web Response, value=Consulting fee