OBJECTIVES This retrospective study aimed to elucidate the impact of the initial site of recurrence on relapse-free survival and post-recurrence survival (PRS) after the curative resection of primary lung cancer. METHODS We enrolled 325 patients who developed recurrence after curative resection of pathological stage I–IIIA primary lung cancer between January 2006 and December 2018 at the Kanagawa Cancer Center. Cases were classified as follows based on the initial site of recurrence: cervicothoracic lymph node (n = 144), lung (n = 121), pleural dissemination (n = 52), bone (n = 59), brain and meningeal dissemination (n = 50) and abdominal organ (n = 34) cases. The relapse-free survival and PRS of patients with and without recurrence at each site were compared using the log-rank test. The impact of the initial site of recurrence on PRS was analysed using the Cox proportional hazards model. RESULTS Relapse-free survival was significantly poorer in patients with abdominal organ recurrence than in patients without abdominal organ recurrence (11.5 vs 17.6 months, P = 0.024). The PRS of patients with bone and abdominal organ recurrences was worse than that of patients without bone (18.4 vs 31.1 months, P < 0.001) or abdominal organ (13.8 vs 30.6 months, P < 0.001) recurrence. Multiple recurrence sites were observed more frequently in patients with bone and abdominal organ recurrences. Bone [hazard ratio (HR) 2.13; P < 0.001] and abdominal organ metastasis (HR 1.71; P = 0.026) were independent poor prognostic factors for PRS. CONCLUSIONS This study suggests surveillance for abdominal organ recurrence in the early postoperative period. Patients with bone and abdominal organ recurrence should receive multimodality treatment to improve their prognosis.

中文翻译：

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初始复发部位对原发性肺癌根治性手术后预后的影响

目的 本回顾性研究旨在阐明初始复发部位对原发性肺癌根治性切除术后无复发生存期和复发后生存期 (PRS) 的影响。方法 我们在 2006 年 1 月至 2018 年 12 月期间在神奈川癌症中心招募了 325 名在病理 I-IIIA 期原发性肺癌根治性切除术后复发的患者。根据最初的复发部位将病例分类如下：颈胸淋巴结（n = 144）、肺（n = 121）、胸膜播散（n = 52）、骨（n = 59）、脑和脑膜播散（n = 50) 和腹部器官 (n = 34) 例。使用时序检验比较每个部位有无复发患者的无复发生存期和 PRS。使用 Cox 比例风险模型分析初始复发部位对 PRS 的影响。结果 腹部器官复发患者的无复发生存期明显低于无腹部器官复发患者（11.5 个月 vs 17.6 个月，P = 0.024）。骨和腹部器官复发患者的 PRS 比无骨（18.4 vs 31.1 个月，P < 0.001）或腹部器官（13.8 vs 30.6 个月，P < 0.001）复发的患者差。在骨和腹部器官复发的患者中更频繁地观察到多个复发部位。骨 [风险比 (HR) 2.13; P＜0.001] 和腹部器官转移 (HR 1.71; P = 0.026) 是 PRS 的独立不良预后因素。结论 本研究建议在术后早期监测腹部器官复发。骨和腹部器官复发的患者应接受多模式治疗以改善其预后。