Retrospective Analysis of Factors Influencing Rate of Recurrence in Non-Small Cell Carcinoma Patients After Curative Surgery

Introduction: Surgical management of NSCLC in its early stage offers the highest long-term chances of survival, either on its own or as a part of multimodality treatment. However, the possibility of cancer recurrence in the future is a real concern and it increases significantly as the disease advances. Till date, there was no comprehensive study to find out the factors influencing the recurrence. Aims: Our aim was to measure the rate of recurrence in lung cancer patients who had curative intent surgery and try to determine any factors that may influence recurrence and survival in patients after lung cancer surgery. Methods: Observational study to investigate the rate and the factors influencing recurrence after lung cancer surgery. 252 patients with lung cancer at East and North Hertfordshire (ENH) NHS Trust who had curative intent surgery between 2010-19 were reviewed. Demographics, co- morbidities, pathological parameters, surgical figures, recurrence, and survival data were collected. Results: The overall recurrence rate noted in the examined cohort was 24.6% (62 patients), with more than half of the cancer recurrences taking place at local and locoregional sites, representing 13.1% (33 patients). Furthermore, 11.51% of the cases (29 patients) were recognized as having distant metastasis. In the univariate analysis of exposure variables, a significant relation was found between tumour location and cancer recurrence, with a p-value of 0.03. Additionally, a correlation between residual tumour status and cancer recurrence was also detected, with a p-value of 0.02. However, no association was noted between the surgical approach and cancer recurrence, indicated by a p-value of 0.06. The multivariate analyses gave only slightly better contributions toward the understanding of the risk of recurrence. Tumour stage and resection margin status were found to be the most important predictors; stage III tumour and positive residual margin, where applicable, were most predictive of recurrence (p - value < 0.01). The surgical approach exhibited a somewhat elevated but statistically insignificant recurrence risk with open thoracotomy compared to VATS, although it approached significance at p ≈ 0.05. In the analysis of continuous variables, age did not indicate any potential association with recurrence. However, when assessed by group, patients aged 75 and older presented a slightly increased recurrence risk, although this difference was not statistically significant at the margin with a p-value of 0.1. Discussion: Interestingly, more than fifty percent of recurrences within our cohort presented at local sites when juxtaposed with distant metastasis. The probability of recurrence escalates concomitantly with progressive tumour staging and the presence of positive residual tumour margins. Both univariate and comprehensive multivariate analyses have indicated that tumour stage III and the status of resection margin adequacy act as significant predictors, with p-values of 0.001 and 0.002, respectively. An elevated incidence of recurrence was noted among patients who underwent open thoracotomy as opposed to those who were subjected to VATS. Nevertheless, the significance of this association was deemed non-specific (p-value of 0.06) in the context of univariate analysis, although it approached significance at p ≈ 0.05 in the realm of multivariate analysis. Moreover, the anatomical localization of the tumour demonstrated a significant correlation with recurrence in univariate analysis with a p-value of 0.03, although it exhibited low accuracy in multivariate analysis. Conclusions: The recurrence rate in patients treated for NSCLC identified in our study is in line with published data. Both univariate and multivariate analysis highlighted the role of tumour staging and extension of tumour resection as the factors determining recurrence. Surgical approach and age were marginally significant secondary predictors whose strength and effect depended on the research context, so they should be interpreted cautiously. Furthermore, the anatomical location of tumour was significantly correlate with recurrence on univariate analysis, although it showed low accuracy on multivariate analysis.