Leveraging Landmark Analysis for Tailored Surveillance in Stage I Non-Small-Cell Lung Cancer

Area of Science:

• Oncology
• Thoracic Surgery
• Pulmonary Medicine

Background:

• Current guidelines for non-small cell lung cancer (NSCLC) lack specific recommendations on surveillance duration post-surgery.
• This study addresses the need for evidence-based follow-up strategies in resected stage I NSCLC.

Purpose of the Study:

• To analyze survival and surveillance data in patients with resected stage I NSCLC.
• To evaluate the long-term impact of follow-up beyond 5 years.
• To propose a tailored surveillance strategy based on risk stratification.

Main Methods:

• Retrospective review of 759 pathological stage I NSCLC patients (9th TNM ed.) undergoing surgery.
• Analysis of overall survival (OS), incidence of relapse (IR), and incidence of new primary lung cancer (NP).
• Landmark analysis of 10-year outcomes for 5-year event-free survivors (5y-EFSs).

Main Results:

• 10-year OS was 75%, 10-year IR was 18%, NP incidence was 1.1%/year, and 5y-EFSs were 59.1%.
• Lower relapse risk and NP incidence were observed in carcinoid and adenocarcinoma without lung nodules (LNs) compared to those with LNs.
• Among 5y-EFSs, conditional 10-year OS was 92%, IR was 5%, and NP incidence was 0.8%/year, with better outcomes for carcinoid/adenocarcinoma and stage IA patients.

Conclusions:

• A tailored surveillance strategy for resected stage I NSCLC is proposed.
• De-escalating follow-up for low-risk patients (e.g., carcinoid, adenocarcinoma without LNs, stage IA) is supported.
• Maintaining intensive monitoring for high-risk individuals (e.g., adenocarcinoma with LNs) is recommended.