Ultra-late recurrence of non-small cell lung cancer over 10 years after curative resection

Abstract

Purpose: Most postoperative recurrences of non-small cell lung cancer (NSCLC) develop within 5 years after curative resection, with ultra-late recurrences developing over 10 years after the resection being rare. This study aimed to analyze the features of ultra-late recurrence in cases with NSCLC who had undergone curative resection.

Patients and methods: Among 1458 consecutive cases with NSCLC who underwent curative resection with systematic lymph node dissection during 1990-2006, 12 cases developed recurrence over 10 years after the resection. We defined the recurrence developing over 10 years after the resection as ultra-late recurrence and analyzed the factors related to it.

Results: Among the 1458 cases, recurrence developed in 476 (32.6%) cases. Of them, ultra-late recurrence developed in 12 (2.5%) cases. The ultra-late recurrence was histopathologically classified as adenocarcinoma in 11 cases and atypical carcinoid in 1 case. All cases were of invasive carcinoma. We compared ultra-late recurrence cases with non-recurrence cases and showed that none of the examined factors significantly influenced ultra-late recurrence; however, lymphatic invasion was close to significantly influencing it. There were two cases in which recurrence developed over 15 years after the resection; both cases were of adenocarcinoma with anaplastic lymphoma kinase (ALK) rearrangement.

Conclusion: There is a possibility of ultra-late recurrence developing over 10 years after the resection of any invasive NSCLC. Lymphatic invasion is close to significantly influencing ultra-late recurrence. Furthermore, a long follow-up period may be required in cases with adenocarcinoma with ALK rearrangement because it has the possibility of recurrence over 15 years after the resection.

Keywords: ALK rearrangement; lung cancer; recurrence; resection.

Figure 1

The pathological findings of the primary tumor and ultra-late recurrent tumor. In both the lesions, tumor cells showed glandular structures containing mucin (acinar adenocarcinoma). The histological findings of the primary and recurrent tumors are quite similar. (A) Hematoxylin and eosin staining of the primary tumor (20×). (B) Anti-anaplastic lymphoma kinase (ALK) antibody staining of the primary tumor (20×). (C) Hematoxylin and eosin staining of the recurrent tumor (20×). (D) Anti-anaplastic lymphoma kinase (ALK) antibody staining of the recurrent tumor (20×).