Nodal stage of surgically resected @entity1149 and its effect on recurrence patterns and XXXX .

@entity1 @entity5 @entity1149 @entity7453 @entity3 @entity204 @entity1349
PURPOSE: Current National @entity5 Network guidelines recommend postoperative radiation therapy (PORT) for @entity1 with resected @entity1149 ( @entity1149 ) with N2 involvement. We investigated the relationship between nodal stage and local-regional recurrence (LR), distant recurrence (DR) and @entity1349 ( @entity1349 ) for @entity1 having an R0 resection. METHODS AND MATERIALS: A multi-institutional database of consecutive @entity1 undergoing R0 resection for stage I-IIIA @entity1149 from 1995 to 2008 was used. @entity1 receiving any radiation therapy before relapse were excluded. A total of 1241, 202, and 125 @entity1 were identified with N0, N1, and N2 involvement, respectively; 161 @entity1 received chemotherapy. Cumulative incidence rates were calculated for LR and DR as first sites of failure, and Kaplan-Meier estimates were made for @entity1349 . Competing risk analysis and proportional hazards models were used to examine LR, DR, and @entity1349 . Independent variables included age, sex, surgical procedure, extent of lymph node sampling, histology, @entity7453 , @entity5 size, @entity5 grade, chemotherapy, nodal stage, and visceral @entity3 . RESULTS: The median follow-up time was 28.7  months. @entity1 with N1 or N2 nodal stage had rates of LR similar to those of @entity1 with N0 disease, but were at significantly increased risk for both DR (N1, hazard ratio [HR]  =  1.84, 95% confidence interval [CI]: 1.30-2.59; P=.001; N2, HR = 2.32, 95% CI: 1.55-3.48; P<.001) and @entity204 (N1, HR = 1.46, 95% CI: 1.18-1.81; P<.001; N2, HR = 2.33, 95% CI: 1.78-3.04; P<.001). LR was associated with squamous histology, visceral pleural involvement, @entity5 size, age, wedge resection, and segmentectomy. The most frequent site of LR was the mediastinum. CONCLUSIONS: Our investigation demonstrated that nodal stage is directly associated with DR and @entity1349 but not with LR. Thus, even some @entity1 with, N0-N1 disease are at relatively high risk of local recurrence. Prospective identification of risk factors for local recurrence may aid in selecting an appropriate population for further study of postoperative radiation therapy.
