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ABSTRACT: OBJECTIVE:: This study investigated the prognostic value of the new International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) lung adenocarcinoma classification in resected stage I lung adenocarcinoma. METHODS:: Histological classification of 283 patients undergoing surgical resection for stage I lung adenocarcinoma was determined according to the IASLC/ATS/ERS classification after comprehensive histological subtyping with recording of the percentage of each histological component (lepidic, acinar, papillary, micropapillary, and solid) in 5% increments. Their impact on overall survival, recurrence, and postrecurrence survival was investigated. RESULTS:: The 5-year overall survival and recurrence-free rates were 81.6% and 76.9%, respectively. During follow-up, 57 (20.1%) patients developed recurrence. The 2-year postrecurrence survival rate was 72.3%. The solid predominant group is associated with significant more male sex, higher smoking exposure, larger tumor size, and more poorly differentiated histological grade. Lepidic predominant group had significantly better overall survival (P = 0.002). Micropapillary and solid predominant groups had significantly lower probability of freedom from recurrence (P = 0.004). Older age (P = 0.039), visceral pleural invasion to the surface (PL2) (P = 0.009), and high grade (micropapillary/solid predominant) of the new classification (P = 0.028) were predictors of recurrence in multivariate analysis. The solid predominant group tends to have significantly worse postrecurrence survival (P = 0.074). CONCLUSIONS:: The new adenocarcinoma classification has significant impact on death and recurrence in stage I lung adenocarcinoma. Patients with PL2 and micropapillary/solid predominant pattern have significant higher risk for recurrence. This information is important for patient stratification for aggressive adjuvant chemoradiation therapy.
Annals of surgery 03/2013; · 7.90 Impact Factor
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ABSTRACT: BACKGROUND: The aim of this study was to investigate whether <5 mm as the narrowest margin width may negatively affect a patient's outcome. METHODS: A prospective cohort study was designed. From January 1994 to July 2010, 196 patients with hepatocellular carcinoma undergoing central hepatectomy were divided into group A (n = 172; narrowest margin, ≥5 to <10 mm) and group B (n = 24; narrowest margin, <5 mm), and outcomes were compared. RESULTS: Significant differences between groups A and B included tumor size (P = .057), infiltrative border (P = .021), satellite lesions (P = .021), and major perivascular abutment (P = .028). Marginal recurrence occurred in 50% of the patients in group B but none of those in group A (P < .001). There were no significant differences between the groups regarding recurrence, recurrence-related death, disease-free survival, and speed of recurrence, but a borderline significant difference was found regarding the cumulative probability of overall survival. After excluding early recurrence (within 1 year), group B had significantly lower cumulative probabilities of disease-free survival (P = .020) and overall survival (P < .001). CONCLUSIONS: In central resections, narrowest margin width of <5 mm does not negatively affect recurrence and overall survival. However, it increases perimargin recurrence and inversely affects late outcomes.
American journal of surgery 02/2013; · 2.36 Impact Factor
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ABSTRACT: Hepatocellular carcinoma (HCC), a worldwide malignancy, is prevalent in Asian countries. For individuals with unresectable HCC, the effect of chemotherapy or the present target therapy is limited. There is an urgent need to find innovative new therapies. It is believed that sonic hedgehog (Shh) pathway activation may be essential for hepatocarcinogenesis. In the present study, we conducted an in vivo animal study using an Shh pathway inhibitor to elucidate the effect of treatment upon mice with HCC. Eighty C57BL/6 mice were divided into 4 groups (groups A, B, C and D, with group A serving as a control; n=20 for each). We injected mouse hepatoma Mistheton Lectin-1 cells (5×10(6) cells/20 μl) into the left liver of each mouse in groups B, C and D. In the second week, we analyzed each mouse to assess the tumor growth status. Following the tumor injection, group B did not receive any additional intraperitoneal (i.p.) injection, group C received cyclopamine 10 mg/kg/day i.p. and group D received cyclopamine 30 mg/kg/day i.p. every day for 10 days. After an interval of 4 weeks, harvesting and analysis of the liver was performed for each mouse. Tumor size measurement and real-time PCR of Shh pathway factors (Shh, Ptch-1, Gli-1 and Smoh) for livers of group A and tumors of group B, C and D were undertaken. The decrease in the tumor size of group D was found to be statistically significant (P= 0.047) when compared with groups B or C. The decrease of Shh mRNA of both groups C and D had borderline significance when compared with group B. However, Gli-1 mRNA of group D has statistically significant difference (P=0.044) when compared with group A, B or C. Inhibition of the Shh pathway significantly decreases the size and Gli-1 mRNA expression of the tumor. The Shh pathway may be an effective treatment target for HCC in the future.
Oncology letters 12/2012; 4(6):1158-1162. · 0.11 Impact Factor
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ABSTRACT: BACKGROUND: Hepatocellular carcinoma (HCC) has a high recurrence rate after resection. Abnormal activation of the sonic hedgehog (SHH) signaling pathway contributing to the carcinogenesis of some organs had been reported. We hypothesize that activation of SHH pathway contributes to the recurrence of HCC after surgical resection. METHODS: In a prospective study, from January 2006 to June 2010, a total of 50 consecutive patients with HCC after curative resection were enrolled. The ratio of the expression of messenger RNA (mRNA) of SHH, patched homolog-1 (PTCH-1) and glioma-associated oncogene-1 (GLI-1) between HCC tissues and the paired noncancerous liver tissues were measured. Both the clinicopathologic characteristics and these ratios were compared between those with recurrence and those without recurrence. They were also compared between those with and without survival. RESULTS: There was a statistically significant correlation among the ratios of PTCH-1 mRNA and serum AFP level (p = 0.045), tumor size (p = 0.001), vascular permeation (p = 0.043) and tumor, node, metastasis staging system (TNM) stage (p = 0.003). A borderline significant correlation was found among ratios of GLI-1 mRNA and tumor size (p = 0.062) and TNM stage (p = 0.051). There was no such significant correlation between SHH mRNA and any parameter. Both the ratios of PTCH-1 mRNA and GLI-1 mRNA significantly adversely affected recurrence (p = 0.003 and 0.005, respectively) and survival (p < 0.001 and <0.001, respectively). CONCLUSIONS: Expression of PTCH-1 mRNA and GLI-1 mRNA in HCC tissues is a potential biomarker to predict postresection disease recurrence.
Annals of Surgical Oncology 08/2012; · 4.17 Impact Factor
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ABSTRACT: This study investigated the factors predicting recurrence and death in patients with resected stage-I non-small-cell lung cancers according to the 7th edition of tumor, node, metastasis (TNM) classification for lung cancer.
All patients undergoing surgical resection for pathological stage-I non-small-cell lung cancers at Taipei Veterans General Hospital between 1980 and 2000 were retrospectively reviewed. Those undergoing sublobar resection were excluded. The factors predicting overall survival (OS), overall recurrence, local recurrence, and distant metastasis were investigated.
A total of 756 patients were eligible. The 5-year OS rate and probability of freedom from recurrence were 57.3% and 70.2%, respectively. The 2-year local-recurrence-free and distant-metastasis-free rates were 90.7% and 82.1%, respectively. In multivariable analysis, the new T descriptor (T1a, T1b, and T2a) was the common factor that significantly affected OS (p = 0.003), overall recurrence (p = 0.004), and distant metastasis (p < 0.001). Smoking index more than 20, and number of mediastinal lymph nodes dissected/sampled of 15 or fewer were common factors that significantly predicted worse OS (p < 0.001, p < 0.001, respectively), lower probability of freedom from overall recurrence (p = 0.025, p = 0.009, respectively), and higher risk of local recurrence (p < 0.001, p = 0.030, respectively). Non-squamous-cell histology predicted higher risk of distant metastasis (p = 0.006).
Risks of death and recurrence increase as the T descriptor upgrades in the new TNM system. The combination of risk factors can be used to identify high-risk subgroups of local recurrence and distant metastasis.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 05/2012; 7(7):1115-23. · 4.55 Impact Factor
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ABSTRACT: Visceral pleural invasion (VPI) has been defined as invasion of the tumor beyond the elastic layer (PL1), including invasion to the visceral pleural surface (PL2). The aim of this study was to evaluate the prognostic factors and patterns of recurrence in resected node-negative non-small cell lung cancer (NSCLC) with VPI.
We retrospectively reviewed the clinicopathologic characteristics of 355 patients with resected node-negative NSCLC with VPI at Taipei Veterans General Hospital between 1990 and 2006. The prognostic value and patterns of recurrence were analyzed and compared between PL1 and PL2 groups.
The median follow-up time was 54.2 months. The 5-year overall survival rate and probability of freedom from recurrence were 61.9% and 66.2%, respectively. The extent of VPI was PL1 in 300 patients (84.5%) and PL2 in 55 (15.5%). During follow-up, 107 patients (30.1%) developed recurrence. The patterns of recurrence included local recurrence only in 20 patients (18.7%), distant metastasis only in 59 (55.1%), and both local recurrence and distant metastasis in 28 (26.2%). Thirteen of the 107 patients (12.1%) with recurrence developed malignant pleural effusion. The percentage of malignant pleural effusion in the PL2 group was significantly higher than that in the PL1 group (P = .006). Patients with PL2 had significantly worse overall survival (P = .046) and lower probability of freedom from recurrence (P = .028) in multivariate analysis.
PL2 was a significant prognostic factor for recurrence and worse overall survival in node-negative NSCLC with VPI. This information is important for further design of clinical trials for aggressive adjuvant therapy.
Chest 01/2012; 142(1):141-50. · 5.25 Impact Factor
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ABSTRACT: BACKGROUND #ENTITYSTARTX00026; AIMS: A combination of pegylated interferon-alpha and ribavirin (PR) is the standard therapy for patients with chronic hepatitis C. The impact of polymorphism of interleukin-28B (IL28B) on sustained virological response (SVR) to PR has been well documented in patients with CHC genotype-1 (GT1), but it is controversial in genotype-2 (GT2) CHC patients. This study investigated the predictability of six single nucleotide polymorphisms (SNP) of IL28B on the treatment responses of PR in patients with CHC GT2. METHOD: 197 CHC GT2 consecutive patients who received PR treatment in our prospective cohort were enrolled. Hepatitis C virus (HCV) genotyping, quantification of HCV-RNA and genotyping of the ten SNPs of IL28B were performed. Six SNPs of IL28B were chosen for analysis. The propensity score matching (PSM) analysis was applied using patients with CHC GT1 in another prospective cohort as a positive comparison to avoid covariate bias. RESULTS: The distribution of the six SNPs was similar in GT1 and GT2 patients. Five of these SNPs had strong association with treatment responses in GT1 but not in GT2 patients. After PSM analysis, these five SNPs still showed strong association with rapid virological response (RVR), cEVR and SVR in GT1 and had no influence in GT2 patients. Furthermore, rs12979860 and baseline viral load were the predictors for both RVR and SVR in GT1 patients. However, only baseline viral load could predict RVR and SVR in GT2 patients. In addition, in patients without RVR, rs12979860 was the only predictor for SVR in GT1 but no predictor for SVR was found in GT2. CONCLUSIONS: The genetic polymorphisms of IL28B had no impact on treatment responses in GT2 patients.
PLoS ONE 01/2012; 7(11):e48217. · 4.09 Impact Factor
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ABSTRACT: The seventh edition of the tumor, node, metastasis classification for lung cancer has been published in 2009. The aim of this study is to evaluate time trends of surgical outcomes and clinicopathologic factors in patients with pathological stage I non-small cell lung cancer according to the seventh edition of the tumor, node, metastasis classification.
We retrospectively reviewed the clinicopathologic characteristics of 1249 patients with pathological stage I non-small cell lung cancer from Taipei Veterans General Hospital between January 1980 and December 2006, during the three periods of 1980-1990, 1991-2000, and 2001-2006. The overall survival, disease-specific survival, and postrecurrence survival were analyzed.
The 5-year overall survival rates during the three periods improved significantly: 53.7, 59.9, and 69.3%, respectively (p < 0.001). The 2-year postrecurrence survival rates during the three periods improved significantly: 10.6, 25.4, and 43.2%, respectively (p < 0.001). The percentage of female patients increased during each period: 15.4, 24.9, and 32.0%, respectively (p < 0.001). The percentage of adenocarcinoma also increased during each period: 51.2, 62.2, and 74.9%, respectively (p < 0.001). Tumor size during each period was 3.2, 3.2, and 2.8 cm, tending to be smaller when diagnosed in the last period (p < 0.001). The overall survival in patients with squamous cell carcinoma and those undergoing pneumonectomy or bilobectomy did not improve over time.
Stage migration, improved postrecurrence survival, increased frequencies of female gender and adenocarcinoma, and decreased tumor size lead to improved overall survival over the past three decades.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 12/2011; 7(2):397-405. · 4.55 Impact Factor
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ABSTRACT: Hepatocellular carcinoma (HCC) is hypervascular. Pigment epithelial derived factor (PEDF), a potent angiogenic inhibitor, usually coexists with the stimulator, vascular endothelial growth factor (VEGF). To assess the treatment effect of PEDF on growing HCCs we conducted this study.
Pathogen-free male LEW/SsN rats (n=150 in 5 groups), group A as control, groups B, C, D and E were given diethyl nitrosamine (DEN) to induce HCC. Group C received intraperitoneal injection (i.p.) of PEDF (0.3mg/kg/day) since induction. Group D received i.p. of PEDF (0.3mg/kg/day) since 18th week (wk). Group E received i.p. of normal saline. We examined VEGF mRNA and PEDF mRNA of livers of group A and 3 different areas (advancing edge, inner edge and central area) of HCC of other 4 groups at 24th wk.
Tumor weight and metastasis score of group C were significantly lower (p=0.026). Comparing among 5 groups, the ratio of VEGF/PEDF mRNA of inner edge of HCC of group C and D were significantly lower (p=0.002 and p=0.011). By multivariate analysis, the difference of group C remains significant (p=0.030).
PEDF significantly suppresses rat hepatocarcinogenesis if given simultaneously since cancer induction. The significant decrease of VEGF/PEDF mRNA is at the inner edge of HCC.
Hepato-gastroenterology 11/2011; 59(117):1484-90. · 0.66 Impact Factor
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ABSTRACT: Serum levels of hepatitis B surface antigen (HBsAg) decrease gradually during chronic hepatitis B virus infection. We investigated the association between levels of HBsAg and HBsAg seroclearance.
We studied data from 46 patients who underwent spontaneous seroclearance of HBsAg (median age at seroclearance, 48 y; 87% male; 76% infected with genotype B). There were 46 controls matched for age, sex, and hepatitis B virus genotype, and e antigen status with persistently normal levels of alanine aminotransferase and seropositive for HBsAg. Levels of HBsAg were assessed in serum specimens collected 5 years 3 years, and 1 year before HBsAg seroclearance (or before the last examination, for controls).
The decrease in HBsAg level was significant and accelerated within the 3 years before HBsAg seroclearance; there was no significant decrease in serum level of HBsAg among controls (P < .0001). The positive predictive value (PPV) for HBsAg seroclearance within 1 year was 36% among patients with HBsAg levels of 200 IU/mL, increasing to 44%, 54%, and 67% among patients with HBsAg levels of 100 IU/mL, 50 IU/mL, or 10 IU/mL, respectively; the negative predictive value (NPV) for these levels was 96% or greater. The combination of HBsAg level less than 200 IU/mL and a decrease of 1 or more log(10) IU/mL in a preceding 2-year period had PPVs of 97% and 100% for HBsAg seroclearance at 1 and 3 years, respectively; the NPVs were 100% and 92%, respectively.
The decrease in the level of HBsAg accelerates during the 3 years before HBsAg seroclearance. Levels of HBsAg of 200 IU/mL or less have high NPVs for HBsAg seroclearance; PPVs increase to 97% to 100% when combined with a 1 log IU/mL or more decrease in level of HBsAg over a 2-year period.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 09/2011; 10(3):297-302. · 5.64 Impact Factor
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ABSTRACT: Laminin-5 has been reported as a prognostic indicator of some malignancies. This prospective study aimed to elucidate the correlation between the ratio of the expression of different laminin-5 subchain mRNAs in HCC tissue and the clinical relevance or prognosis of patients.
Using RT-PCR, a3, ß3 and ?2 mRNA levels were determined prospectively from 29 patients with HCC undergoing curative resection. The ratio of the value of each subchain mRNA in HCC tissue to non-cancerous liver tissue was measured.
The mRNA of a3, ß3 and ß2 was detected in both HCC tissue and the liver remnants in 29 (100%), 29 (100%) and 28 (96.5%) patients, respectively. The ratio of ?2 mRNA correlated with the absence of complete encapsulation (p=0.033) and with the presence of hepatitis, with borderline significance (p=0.081). The ratio of a3 mRNA correlated with tumor hemorrhage and tumor necrosis with borderline significance (p=0.082 and p=0.082, respectively). The ratios of a3, ß3 and ?2 mRNA did not correlate significantly with postresection recurrence, recurrence and patient survival.
Expression of a3, ß3 and ?2 cannot predict the prognosis. However, high expression of ?2 mRNA in HCC/non-cancerous liver correlated significantly with the absence of complete encapsulation, which is an important tumor invasiveness factor.
Hepato-gastroenterology 07/2011; 58(110-111):1680-6. · 0.66 Impact Factor
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ABSTRACT: To investigate the outcomes, as well as risk factors for 6-wk mortality, in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).
Among 817 EVL procedures performed for EVH between January 2007 and December 2008, 128 patients with early rebleeding, defined as rebleeding within 6 wk after EVL, were enrolled for analysis.
The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817). The 5-d, 6-wk, 3-mo, and 6-mo mortality rates were 7.8%, 38.3%, 55.5%, and 58.6%, respectively, in these early rebleeding patients. The use of beta-blockers, occurrence of hypovolemic shock, and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality. A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value were 77.6%, 81%, 71.7%, and 85.3%, respectively. As for the 6-mo survival rate, patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001).
This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH.
World Journal of Gastroenterology 04/2011; 17(16):2120-5. · 2.47 Impact Factor
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ABSTRACT: Single nucleotide polymorphisms (SNPs) of interleukin-28B (IL28B) have received considerable interest for their association with sustained virological response (SVR) when treating patients of genotype-1 hepatitis C virus (GT1-HCV) chronic infection with pegylated interferon and ribavirin (PegIFN/RBV). This study was to investigate the predictive power of IL28B SNPs for on-treatment responses and SVR in treatment-naïve patients with GT1-HCV chronic infection.
We analyzed ten SNPs of IL28B in 191 treatment-naïve patients with GT1-HCV chronic infection who received PegIFN/RBV. In these patients, rapid virological response (RVR), early virological response (EVR) and SVR were achieved in 69.6%, 95.8% and 68.6% of the patients, respectively. Multivariate analysis (odds ratio; 95% confidence interval; P value) indicated age (0.96; 0.93-0.99; 0.012), low baseline viral load (4.65; 2.23-9.66; <0.001) and CC genotype of rs12979860 (7.74; 2.55-23.53; <0.001) but no other SNPs were independent predictors for SVR. In addition, none of the ten SNPs examined were associated with baseline viral load and stages of liver fibrosis. Regarding RVR, low baseline viral load (2.83; 1.40-5.73; 0.004) and CC genotype of rs12979860 (10.52; 3.45-32.04; <0.001) were two critical predictors. As for EVR, only CC genotype of rs12979860 (36.21; 6.68-196.38; <0.001) was the predictor. Similarly, for end of treatment response (ETR), CC genotype of rs12979860 (15.42; 4.62-51.18; <0.001) was the only predictor. For patients with RVR, only low baseline viral load (3.90; 1.57-9.68; 0.003) could predict the SVR. For patients without RVR, only rs12979860 (4.60; 1.13-18.65; 0.033) was the predictor for SVR.
rs12979860 is the critical predictor for RVR, EVR, ETR and SVR in treatment-naïve patients of GT1-HCV chronic infection. Furthermore, this SNP is the only predictor for SVR in patients without RVR. These results have provided evidence that rs12979860 is the ideal IL28B SNP for genetic testing in treating patients of GT1-HCV chronic infection.
PLoS ONE 01/2011; 6(3):e18322. · 4.09 Impact Factor
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ABSTRACT: The goal of this study was to investigate the prognostic factors and patterns of recurrence in patients with resected non-small cell lung cancer (NSCLC) < or = 1 cm in diameter.
We conducted a retrospective review of the clinicopathological characteristics of 71 patients with NSCLC < or = 1 cm in diameter in Taipei Veterans General Hospital between 1982 and 2007. Overall survival and its predictors were analyzed.
Median follow-up time of the 71 patients was 33.3 months. Complete resection was performed in 68 patients (95.8%) with stage I disease. The 5- and 10-year overall survival rates of patients who underwent complete resections were 81.7% and 44.9%, respectively. There was tumor recurrence in 6 (8.8%) of these 68 patients. Five (9.3%) of 54 patients who underwent standard resection experienced tumor recurrence, but only 1 (7.1%) of 14 patients who received sublobar resection had recurrent disease. The difference was not statistically significant (p = 0.569). Multivariate analysis revealed that sublobar resection (hazard ratio, 5.00; 95% confidence interval, 1.28-20.00; p = 0.020) was a significant predictor for worse overall survival.
Survival in patients with NSCLC pound 1 cm in diameter is satisfactory. Sublobar resection, performed in patients unfit for standard resection, is a poor prognostic factor for overall survival.
Journal of the Chinese Medical Association 06/2010; 73(6):308-13. · 0.79 Impact Factor
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The lancet oncology 05/2010; 11(5):412-3; author reply 413. · 14.47 Impact Factor
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Annals of surgery 05/2010; 251(5):990; author reply 990-1. · 7.90 Impact Factor
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ABSTRACT: Acute exacerbations of chronic hepatitis B virus (HBV) infection can lead to hepatic decompensation. It is important to identify factors that predict the development of hepatic decompensation during exacerbation so that antiviral therapy can be initiated immediately.
Acute exacerbation, defined by an abrupt increase in alanine aminotransferase (ALT) levels to >5-fold the upper limit of normal, occurred in 110 hepatitis B e antigen (HBeAg)-seropositive non-cirrhotic patients (138 episodes). The patients were monitored every 1 to 2 weeks for serum levels of ALT, bilirubin, albumin, and prothrombin. Sex, age, HBV genotype, ALT level, HBV viral load, and the causes (spontaneous or relapse from antiviral treatment) of exacerbation were included in multivariate logistic regression analyses. The receiver operating characteristic curve was used to identify the optimal cut-off value of serum HBV DNA level to identify patients at risk for decompensation.
Seven of the 138 episodes of acute exacerbation (5.1%) resulted in hepatic decompensation; serum HBV DNA level was the only significant risk factor (P = .003). The area under the receiver operating characteristic curve was 88.6% (P < .001). A serum HBV DNA cut-off value of 1.55 x 10(9) copies/mL predicted decompensation with a sensitivity of 85.7%, a specificity of 85.5%, a negative prediction value of 99.1%, and positive prediction value of 24.0%.
During acute exacerbation of HBeAg-positive chronic hepatitis B, a serum HBV DNA cut-off value of 1.55 x 10(9) copies/mL can be used to identify patients in need of immediate antiviral therapy.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2010; 8(6):541-5. · 5.64 Impact Factor
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ABSTRACT: Distant metastasis after surgical resection is the most frequent cause of death in patients with non-small cell lung cancer (NSCLC). This study aimed to investigate the patterns of distant metastasis and the prognostic factors of postrecurrence survival in patients with resected stage I NSCLC with distant metastases.
The clinicopathological characteristics of 166 patients with distant metastases after complete resection of stage I NSCLC at Taipei Veterans General Hospital between 1980 and 2000 were retrospectively reviewed. The patients were divided into two groups according to patterns of distant metastasis (single or multiple organ metastases). Predictors of postrecurrence survival were analysed.
The patterns of distant metastasis included single organ metastasis in 106 (63.9%) and multiple organ metastases in 60 (36.1%) patients. The 1- and 2-year postrecurrence survival rates for those with single organ metastasis were 30.2% and 15.1%, respectively. The most common site of single organ metastasis was bone (32.1%), followed by the brain (29.2%). Multivariate analysis revealed that disease-free interval >16 months (HR 0.534; 95% CI 0.288 to 0.990; p=0.046) and treatment for distant metastasis (including re-operation, chemotherapy and/or radiotherapy) (HR 0.245; 95% CI 0.089 to 0.673; p=0.006) were significant predictors of better postrecurrence survival in resected stage I NSCLC with single organ metastasis.
A longer disease-free interval is a favourable prognostic predictor for postrecurrence survival in resected stage I NSCLC with single organ metastasis. Treatment for distant metastasis significantly prolongs postrecurrence survival.
Thorax 03/2010; 65(3):241-5. · 6.84 Impact Factor
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New England Journal of Medicine 10/2009; 361(16):1606-7; author reply 1608. · 53.30 Impact Factor
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American Journal of Respiratory and Critical Care Medicine 10/2009; 180(8):794; author reply 794-5. · 11.08 Impact Factor
