Factors predicting patterns of recurrence after resection of N1 non-small cell lung carcinoma

Background. Although irradiation and chemotherapy are unproved adjuvant tre atments for completely resected N1 non-small cell lung carcinoma, previous studies may have been diluted by the inclusion of low-risk patients. Risk f actors in this situation, however, are not yet well defined. Methods. One hundred seven consecutive patients with complete resection of N1 disease who received no other therapy were studied to identify factors i ndependently predicting the risk of freedom from local recurrence (FFLR), f reedom from distant metastasis (FFDM), and overall survival (OS). Results. Twelve factors were assessed for a potential prognostic relationsh ip with FFLR, FFDM, and OS. Regression analyses revealed that the factors i ndependently associated with an improved outcome were positive bronchoscopi c findings (FFLR, p = 0.005), a greater number of dissected N1 nodes (FFDM, p = 0.02), and a lesser T stage (OS, p = 0.01). Classification and regress ion tree analyses were then used to separate the patients into risk groups. Conclusions. Although these results require corroboration in further studie s, they may aid the design of trials examining therapies used to decrease r ates of local recurrence or distant metastasis. (C) 1999 by The Society of Thoracic Surgeons.