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Researchers identify risks for recurrence, mortality based on lung cancer stage
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The risk for recurrence and the risk for mortality after recurrence varied according to lung cancer stage at diagnosis, according to results of a population-based study.
These findings may help guide more effective adjuvant treatments for patients with lung cancer based on their specific disease subgroup, researchers wrote.
“Local extension and metastases are primary causes of death in lung cancer patients,” Maria Teresa Landi, MD, PhD, of the division of cancer epidemiology and genetics at the NCI, and colleagues wrote. “Identifying subsets of patients at high risk for recurrence and mortality following recurrence may lead to interventions that improve survival.”
Landi and colleagues evaluated data from 2,098 patients from Lombardi, Italy, who were diagnosed with lung cancer from 2002 to 2005. The mean age of the population ranged from 63.7 to 68.8 years, and nearly 80% were men.
The population included patients with stage IA to IIIA lung cancer who underwent surgical (n = 760) or nonsurgical (n = 258) treatment, and patients with stage IIIB to IV lung cancer who underwent surgical (n = 61) or nonsurgical (n = 971) treatment.
Median follow-up ranged from 8.4 months to 4.1 years.
Results indicated mortality rates were associated with cancer stage at diagnosis. Among surgically treated patients, the HR for death increased from 1.34 (95% CI, 0.92-1.94) among patients diagnosed with stage IB disease to 3.29 (95% CI, 2.35-4.6) among patients diagnosed with stage IIIA disease compared with patients diagnosed with stage IA disease. However, researchers noted the survival difference was modest between nonsurgically treated patients diagnosed with stage IV disease vs. stage IIIB disease (HR = 1.46; 95% CI, 1.24-1.72).
Mortality rates were worse among nonsurgically treated patients with stage I to IIIA disease compared with surgically treated patients with the same disease stage (HR = 3.46; 95% CI, 2.91-4.1). Surgically treated patients with stage IIIB and stage IV disease also fared better than nonsurgically treated patients (HR = 0.4; 95% CI, 0.3-0.54).
Local or distant recurrence occurred in 49.3% of surgically treated patients and 26.6% of nonsurgically treated patients. Researchers noted the lower rate for recurrence in the nonsurgical cohort can be linked to the competing risk for mortality.
The rate of recurrence in the surgically treated cohort was comparable among patients with adenocarcinoma and squamous cell carcinoma and increased with disease stage. However, the risk for recurrence was lower in patients with squamous cell carcinoma than adenocarcinoma in the nonsurgically treated cohort (HR = 0.68; 95% CI, 0.46-0.99).
Overall, the absolute risk for metastases was greater than the absolute risk for local recurrence in every stage and cell type.
The risk for death within 1 year increased with disease stage and after recurrence. Among patients with stage IA disease, the 1-year mortality rate was 2.7% before recurrence and 48.3% after recurrence (HR = 34.2; 95% CI, 21.9-53.3). Among patients with stage IV disease, the 1-year mortality rate increased from 57.3% before recurrence to 80.6% after recurrence (HR = 2.24; 95% CI, 1.89-2.65).
The researchers said the lack of data on performance status may be a limitation to these findings.
“This population-based study provides clinically useful estimates of risks of lung cancer recurrence and mortality that are applicable to the general population,” Landi and colleagues wrote. “These data highlight the need for more effective adjuvant treatments overall and within specific subgroups. The estimated risks of various endpoints are useful for designing clinical trials, whose power depends on absolute number of events.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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