ABSTRACT
Aim: Assess the long-term survival and quality-of-life outcomes in early-stage NSCLC (eNSCLC) patients. Methods: Review of long-term survival and quality-of-life after curative treatment in eNSCLC patients in observational studies. Results: Disease-free proportion decreased in stage III vs stage I patients. Recurrence-free proportion decreased with age and disease stage. Advanced stage and vascular invasion increased risk of late recurrence. Conditional 5-year relative survival rates did not exceed 87%, indicating higher mortality in eNSCLC survivors. Lower conditional survival rates and relative survival rates were associated with older age and advanced disease. Survivors of eNSCLC had poorer physical quality-of-life. Conclusion: Despite curative-intent therapy, survivors of eNSCLC still face significant risks of recurrence, excess mortality, and diminished quality-of-life.
Early-stage NSCLC (eNSCLC) encompassing stage I and II, and resectable stage III disease is initially managed with curative-intent surgery and adjuvant chemotherapy to reduce the risk of recurrence. However, understanding the true curative potential and long-term outcomes is crucial for optimal clinical management. A literature review was conducted to identify observational studies describing long-term survival and quality-of-life outcomes following curative intent therapy in patients with eNSCLC. The proportion of patients who remained disease-free over time (without recurrence or death) statistically significantly decreased in patients with stage III disease compared with stage I disease. Similarly, the proportion of patients who remained recurrence-free over time decreased with increasing age and disease stage. A considerable risk of late recurrence (recurrence five or more years following resection) remained, increasing with advanced stage and tumor characteristics such as vascular invasion. Conditional 5-year relative survival rates did not exceed 87% in any study, indicating higher rates of all-cause mortality in long-term survivors of eNSCLC compared with members of the general population of the same age. Lower conditional 5-year relative survival rates, and 5 and 10-year relative survival rates were associated with older age and higher pathologic stage. Compared with the general population, survivors of eNSCLC reported significantly poorer physical quality-of-life, suggesting that symptoms persist after treatment. Overall, real-world evidence suggests that after standard curative-intent therapy, survivors of eNSCLC may not be considered fully cured, indicating a need for more effective adjuvant treatment in addition to the current standard of care.
ABSTRACT
Approximately 10-50% of patients treated for early-stage (I-III), resectable non-small cell lung cancer (eNSCLC) will develop locoregional recurrence. There is a lack of prospective trials evaluating optimal post-surgery follow-up for this patient population, and treatment guidelines recommend salvage therapies such as surgery, local ablative therapy, and (chemo)radiotherapy. A literature review was conducted according to pre-defined criteria to identify observational studies describing treatment patterns and survival outcomes in patients with eNSCLC who experienced locoregional recurrence. Results showed that, in real-world clinical practice, around 80% of patients with locoregional recurrence underwent any form of active treatment. The most frequently administered treatments were chemotherapy (35.7%), chemoradiotherapy (31.2%), radiotherapy (20.3%), and surgery alone (12.8%). Chemoradiotherapy was associated with improved PFS and OS compared with radiotherapy, while no statistically significant survival benefits were observed for patients receiving surgery in addition to these treatments. The overall survival of patients following treatment for locoregional recurrence was generally poor, and the proportion of patients who experienced any form of post-treatment re-recurrence ranged from 35 to 72%. These findings highlight the need to develop more effective treatment strategies for locoregional recurrence, including preventative treatments, and strategies to improve the survival outcomes of those who do develop locoregional recurrence.
