Fate of Newly Detected Lesions During Postoperative Surveillance for Non-Small Cell Lung Cancer

Abstract

Background. Chest computed tomography (CT) is the mainstay of postoperative surveillance for non-small cell lung cancer (NSCLC). However, there is no clear consensus about the optimal management of newly detected lesions on follow-up CT. Our goals were (1) to determine the eventual outcome of newly detected lesions on follow-up CT in patients with previously resected NSCLC and (2) to determine the characteristics of the detected lesions that suggest recurrence. Methods. In this retrospective study, we investigated 116 patients with NSCLC who underwent operations between February 2004 and December 2011 and had newly detected lesions on postoperative surveillance CT at least once during the follow-up period (median, 29 months). We investigated lesion size, growth, laterality, multiplicity, and recurrence patterns, as well as demographic data. Results. One hundred fifty-seven new lesions were detected during the follow-up period. Of the 157 lesions, 139 were intrathoracic (lung, 83; lymph node, 34; pleura, 14; others, 8) and 18 were extrathoracic. Further investigation or follow-up confirmed that 78 lesions (49.7% [78 of 157]) were recurrences. Extrathoracic lesions showed a higher correlation with recurrence compared with intrathoracic ones (83.3% versus 45.3%; p =0.002). Regarding lung lesions, solid nodules (p = 0.003; hazard ratio, 13.190) and lesions in patients with stage III disease (p = 0.043; hazard ratio, 6.464), were much more likely to reflect recurrence. Conclusions. In patients with newly detected lesions on follow-up chest CT after resection of NSCLC, special attention should be paid to lesions with the following characteristics: extrathoracic lesions, solid lung nodules, and lung lesions in patients with stage III disease. It is necessary to investigate these lesions more aggressively because they suggest the presence of recurrent disease. (C) 2013 by The Society of Thoracic Surgeons