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Clinical, behavioral factors predict lung cancer recurrence
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DENVER — Several factors, including the presence of a nodule on CT scan and persistent metaplasia, served as significant predictors of lung cancer recurrence or the development of secondary primary lung cancers, according to study results presented at the American Thoracic Society International Conference.
“This suggests that aggressive ongoing surveillance of lung cancer survivors may be needed for extended periods of time,” Samjot Dhillon, MD, associate professor of oncology at Roswell Park Cancer Institute, and colleagues wrote.
Samjot Dhillon
Lung cancer accounts for approximately 27% of all cancer deaths, and more than 158,000 Americans are expected to die of the disease this year, according to the American Lung Association. About half of patients with lung cancer have advanced disease at the time of diagnosis.
Widespread adoption of screening for high-risk individuals who meet age and smoking history criteria is expected to increase detection of lung cancers at earlier, more treatable stages. However, survival for individuals whose disease is diagnosed at an earlier stage often remains low due to the high likelihood of recurrence or the development of second primary tumors, according to study background.
Dhillon and colleagues evaluated data on 192 lung cancer survivors (mean age, 62 years) treated at three institutions to identify factors that contribute to recurrence.
All participants completed definitive treatment with no evidence of active disease. They subsequently underwent surveillance with autofluorescence bronchoscopy and chest CT.
The investigators used medical records from the participating institutions to obtain CT and autofluorescence bronchoscopy results. They also collected information about major risk factors, including prior cancers, respiratory disease, asbestos exposure, smoking status and pack-year history, and family history of lung cancer.
Results showed 95% of participants had a smoking history (median pack-years, 56; range, 35-81).
The mean duration of surveillance was 8.3 years. During that time, 72 (38%) participants experienced lung cancer recurrence or developed a new primary lung cancer.
Researchers used Cox proportional hazards analysis to identify four factors that significantly predicted lung cancer recurrence or new primary lung cancers. The most predictive factors were metaplasia on three autofluorescence bronchoscopy exams in the upper airway (HR = 5.9; 95% CI, 1.7-21.4) and presence of a nodule on CT, regardless of location or size (HR = 5.2; 95% CI, 1.8-14.5). Other significant predictors included recurrence of another cancer type (HR = 4.8; 95% CI, 2.2-10.6) and pack-year smoking history (HR for each additional pack-year = 1.01; 95% CI, 1-1.01).
“Along with close medical surveillance for lung cancer recurrence, it is also important for patients to stop smoking as soon as possible since this is a known risk,” Dhillon said in a press release.
Further investigation into the factors that predict lung cancer recurrence or secondary primary tumors in this population may help identify appropriate targeted interventions, Dhillon and colleagues concluded. – by Mark Leiser
Reference:
Dhillon S, et al. Abstract 67841. Presented at: American Thoracic Society International Conference; May 15-20, 2015; Denver.
Disclosure: The researchers report no relevant financial disclosures.