Recurrence-Free Survival in Patients With Surgically Resected Non-Small Cell Lung Cancer

Background

Standard treatment for early-stage or locoregionally advanced non-small cell lung cancer (NSCLC) includes surgical resection. Recurrence after surgery is commonly reported, but a summary estimate for postsurgical recurrence-free survival (RFS) in patients with NSCLC is lacking.

Research Question

What is the RFS after surgery in patients with stage I-III NSCLC at different time points, and what factors are associated with RFS?

Study Design and Methods

A systematic search was performed in MEDLINE, EMBASE, and Cochrane databases between January 2011 and June 2021. The primary outcome was RFS at 1, 2, 3, and 5 years postresection. Single-arm, random-effects meta-analyses were done to calculate effect estimates and 95% CIs. Analyses were stratified by stage/substage as per the AJCC Cancer Staging Manual, and RFS was estimated (1) after pooling studies, using 7th or 8th edition staging criteria; and (2) among studies using only the 8th edition. Meta-regressions were performed to assess associations between RFS and patient demographic/clinical characteristics of interest.

Results

Data from 471 studies comprising 1,060 surgical study arms were extracted. RFS estimates from 60,695 patients staged with the 7th or 8th edition were analyzed. RFS ranged from 96% at 1 year postresection to 82% at 5 years for stage I, and from 68% at 1 year to 34% at 5 years for stage III. Estimates for patients staged using only 8th edition criteria were slightly higher. Older age, higher percentage of male patients, advancing stage, larger tumor size, and geographical region (North America/Europe vs Asia) were significantly associated with worse RFS.

Interpretation

This study presents a comprehensive assessment of reported RFS from published clinical literature, offering estimates at multiple postsurgical time points and by geographical region. Findings can inform treatment decisions, clinical trial design, and future research to improve outcomes among patients with NSCLC.