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A Clinical Model to Estimate Recurrence Risk in Resected Stage I Non-Small Cell Lung Cancer

Goodgame, Boone, MD*; Viswanathan, Avinash, BS*; Miller, C Ryan, MD, PhD; Gao, Feng, MPH, PhD; Meyers, Bryan, MD, MPH§∥¶; Battafarano, Richard J., MD, PhD§∥¶; Patterson, Alexander, MD§∥¶; Cooper, Joel, MD§∥¶; Guthrie, Tracey J., BSN∥¶; Bradley, Jeffrey, MD**; Pillot, Giancarlo, MD*; Govindan, Ramaswamy, MD

American Journal of Clinical Oncology: February 2008 - Volume 31 - Issue 1 - p 22-28
doi: 10.1097/COC.0b013e3180ca77d1
Original Article: Thoracic
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Objective: There are no reliable markers to predict recurrence in resected Stage I non-small cell lung cancer (NSCLC). A validated clinical model to estimate the risk of recurrence would help select patients for adjuvant therapy.

Methods: We reviewed the medical records of 715 patients who had a potentially curative resection for Stage I NSCLC at our institution from 1990 to 2000. Recurrence rates were estimated by the Kaplan-Meier method. A model to estimate risk of recurrence was developed by combining independent risk factors.

Results: With a median follow-up of 4.7 years, the 5-year survival rates for Stages IA and IB were 66% and 55% respectively, and 5-year recurrence rates were 19% and 30%, respectively. Four factors were independently associated with tumor recurrence: tumor size >3 cm (hazard ratio [HR] = 2.4), surgery other than lobectomy (HR = 2.0), nonsquamous histology (HR = 1.4), and high-grade cellular differentiation (HR = 1.4). A scoring system for recurrence was developed by assigning 2 points for each major risk factor (tumor size and surgery) and 1 point for each minor risk factor (histologic subtype and cellular grade). Scores were grouped as low (0–1), intermediate (2–3), and high (>3), yielding 5-year estimates of risk of recurrence of 14%, 27%, and 43%, respectively.

Conclusion: This model, based upon readily available clinicopathologic characteristics, can estimate the risk of recurrence in Stage I NSCLC, independent of T classification. This model could be used to select patients for adjuvant therapy if validated in independent data sets.

From the *Division of Medical Oncology and Department of Medicine, †Department of Pathology, ‡Division of Biostatistics, §Alvin J. Siteman Cancer Center, ∥Department of Surgery, Division of Cardiothoracic Surgery, and **Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.

Prior Presentation: B. Goodgame, A. Viswanathan, G. Pillot, F. Gao, D. Morgensztern, J. Bradley, T. Guthrie, R. Battafarano, R. Govindan. Outcomes in 708 resected Stage I non-small cell lung cancer (NSCLC) subjects and a prognostic index for relapse. Proceedings of the Annual Meeting of the American Society of Clinical Oncology, Orlando, Florida, May 13–17, 2005 [Abstract No: 7198].

Reprints: Ramaswamy Govindan, MD, Division of Medical Oncology, Washington University School of Medicine, 660 S. Euclid, Campus Box 8056, St. Louis, MO 63110. E-mail: govindan@im.wustl.edu.

© 2008 Lippincott Williams & Wilkins, Inc.