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Ann Thorac Surg 2006;81:1021-1027
© 2006 The Society of Thoracic Surgeons
a Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
b Division of Epidemiology and Cancer Center, Mayo Clinic College of Medicine, Rochester, Minnesota
c Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
Accepted for publication September 9, 2005.
* Address correspondence to Dr Yang, Department of Health Sciences Research, Mayo Clinic Cancer Center, 200 First St SW, Charlton 6-261, Rochester, MN 55905 (Email: yang.ping{at}mayo.edu).
BACKGROUND: Survival after recurrence subsequent to complete resection of nonsmall-cell lung cancer (NSCLC) has been considered a multifactorial process dependent on demographic, clinical, biological, and treatment characteristics. This study sought to quantify the prognostic effects of these characteristics on postrecurrence survival.
METHODS: Three hundred ninety NSCLC patients who underwent complete resection and subsequently had recurrent cancer were studied. The associations between characteristics of both the initial and recurrent disease with postrecurrence survival were evaluated by Cox proportional hazards models. A multivariable Cox model determined those factors most strongly associated with postrecurrence survival . A simple algorithm based on this model facilitates estimating risk of postrecurrence mortality, as quantified by risk score points.
RESULTS: The factors most strongly associated with postrecurrence survival were performance status at recurrence (3 or 4, 4.2 points; 2, 2.8 points; and 1, 1.5 points), symptoms at recurrence (3.6 points), liver recurrence (2.3 points), initial lung cancer stage IIB or worse (1.8 points), and multiple recurrences (1.0 points). Based on these factors, patients were stratified as low risk (4.0 or fewer total points), moderate-low risk (4.1 to 6.1 points), moderate-high risk (6.1 to 8.0 points), and high risk (more than 8.0 points), with 12-month survival of 75%, 51%, 25%, and 9%, respectively. Postrecurrence survival was significantly different across groups (p < 0.01).
CONCLUSIONS: The proposed prediction instrument offers clinicians a succinct tool for rapidly evaluating mortality risk after recurrence. The characteristics comprising this instrument can be easily ascertained and measured, making it of potential clinical value.
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 T. A. D'Amico Invited commentary Ann. Thorac. Surg., March 1, 2006; 81(3): 1027 - 1027. [Full Text] [PDF]
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