The risk of recurrence in pathological stage II-IIIA non-small cell lung cancer without lymph node metastasis

According to LACE analysis, patients diagnosed with p-Stage II-III non-small cell lung cancer (NSCLC) are usually indicated for adjuvant chemotherapy, including platinum doublets. We aimed to identify the risk of recurrence in NSCLC patients without lymph node metastasis.

Between 2009 and 2018, 187 patients underwent lung resection of one or more lobes and mediastinal lymph node dissection for p-Stage II-IIIA NSCLC. Among them, 112 were included after excluding those with a history of lung cancer, perioperative chemotherapy. Staging was based on 8th Edition of IASLC staging system. Multivariate analysis was performed to identify important prognostic factors for oncologic outcomes.

Among the evaluated patients, 84 were male, and with a median age of 67 years. Seventy-one (51.4 %) patients were diagnosed with adenocarcinoma. The cancer stages were stage IIA in 34 patients, stage IIB in 57 patients, and stage IIIA in 21 patients. Multivariate analysis of disease-free survival revealed that vascular invasion (HR, 2.481; 95 %CI, 1.411-4.362, P < 0.01) and pathological T factor (HR, 1.819; 95 %CI, 1.226-2.699, P < 0.01) were the independent risk factors. Gray's test for equality of cumulative incidence functions revealed that the five-year cumulative incidence of recurrence was particularly high in patients with vascular invasion compared to that in patients without vascular invasion (21.5 % vs. 37.5 %, P = 0.03).

Vascular invasion is a significant predictor of lung cancer recurrence in patients with p-Stage II-IIIA NSCLC without lymph node metastasis. The patients without vascular invasion in this cohort had a favorable prognosis, with a 5-year recurrence rate of 21.5 %.