Armin Kiankhooy, MD, Matthew D. Taylor, MD, Damien J

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Predictors of Early Recurrence for Node-Negative T1 to T2b Non-Small Cell Lung Cancer Armin Kiankhooy, MD, Matthew D. Taylor, MD, Damien J. LaPar, MD, MS, James M. Isbell, MD, MSCI, Christine L. Lau, MD, MBA, Benjamin D. Kozower, MD, MPH, David R. Jones, MD The Annals of Thoracic Surgery Volume 98, Issue 4, Pages 1175-1183 (October 2014) DOI: 10.1016/j.athoracsur.2014.05.061 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Early recurrence (<2 years) is shown for node-negative stage IA to IIA non-small cell lung cancer. Recurrence after R0 resection steadily increases over the 2-year period. The mean time for early cancer recurrence was 1.1 years or 414 days (vertical dashed line). The Annals of Thoracic Surgery 2014 98, 1175-1183DOI: (10.1016/j.athoracsur.2014.05.061) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Predictors of early recurrence and their strength of association were analyzed by Wald statistic. Age (9.1), lymphovascular invasion (LVI; 8.1), and sublobar resection (7.9) demonstrated the greatest degree of association with early recurrence. (DM = diabetes mellitus; G-poor = grade poorly differentiated; G-well = grade well differentiated.) The Annals of Thoracic Surgery 2014 98, 1175-1183DOI: (10.1016/j.athoracsur.2014.05.061) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The effect of sublobar resection (red line) compared with lobectomy (blue line) on freedom from recurrence was analyzed by Cox proportional hazards analysis. Patients undergoing sublobar resection (wedge or segmentectomy) were at a significantly greater risk (hazard ratio, 2.19; 95% confidence interval, 1.24 to 3.58; p = 0.002) for early recurrence despite an R0 resection. The Annals of Thoracic Surgery 2014 98, 1175-1183DOI: (10.1016/j.athoracsur.2014.05.061) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The effect of lymphovascular invasion (no = blue line; yes = red line) on freedom from recurrence was analyzed by Cox proportional hazards analysis. Patients undergoing sublobar resection (wedge or segmentectomy) were at a significantly greater risk (hazard ratio, 2.69; 95% confidence interval, 1.62 to 4.49; p < 0.001) for early recurrence despite an R0 resection. The Annals of Thoracic Surgery 2014 98, 1175-1183DOI: (10.1016/j.athoracsur.2014.05.061) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Predictors of recurrence were analyzed by location—local (dark gray), distant (medium gray), or multisite (black)—compared with no recurrence (light gray). Subset univariable analysis revealed sublobar resection (13.9% vs 5.7%, p = 0.016) was a risk factor for local recurrence risk. Interestingly, lymphovascular invasion (LVI; 17.9% vs 5.2%, p = 0.007), sublobar resection (11.7% vs 5.2%, p = 0.042), and younger age (68.1 ± 9.7 vs 62.9 ± 10.8 years, p = 0.007) were all associated with an increased rate of multisite recurrence. The Annals of Thoracic Surgery 2014 98, 1175-1183DOI: (10.1016/j.athoracsur.2014.05.061) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions