Background. Although early stage non-small cell lung cancer (NSCLC) has an excellent outcome and correlated with good long-term survival, up to 15 percent of patients still relapse postoperatively and die. This study is conducted to identify prognostic factors that may affect the long-term survival in completely resected N0 NSCLC. Methods. Medical records of 124 patients with completely resected N0 NSCLC were retrospectively reviewed. Prognostic factors affecting long-term survival were analyzed by the Kaplan-Meier method and Cox proportional hazards analysis. Results. Overall five-year survival rate was 48 percent. Multivariable analysis revealed stage of disease, tumor necrosis, tumor recurrence, brain metastasis, adrenal metastases, and skin metastases as significant prognostic factors affecting long-term survival. The hazard ratio (HR) of tumor necrosis, tumor recurrence, brain metastasis, adrenal metastases, and skin metastases was 2.0, 2.3, 7.6, 4.1, and 8.3, respectively, and all P values were less than 0.001. Conclusions. Our study shows stage of disease, tumor necrosis, tumor recurrence, brain metastasis, adrenal metastasis, and skin metastasis as the independent prognostic factors of long-term survival in pathological N0 NSCLC. Early stage NSCLC patients without nodal involvement or presented with tumor necrosis should benefit from adjuvant chemotherapy, and sites of metastasis could predict the long-term survival as described. 1. Introduction The curative treatment for early stage non-small cell lung cancer (NSCLC) patients without nodal involvement is surgery alone; however, some pathological characteristics may be associated with poor prognostic of long-term survival. Overall 5-year survival rates in completely resected stages IA and IB NSCLC range from 67 to 89% and from 57 to 75%, respectively; therefore, there are some poor prognostic factors that affect the overall survival despite presenting in the same stage [1–4]. Recently, some prognostic factors such as intratumoral blood vessel invasion (IVI), intratumoral lymphatic invasion (ILI), visceral pleural invasion, tumor size, and serum level of carcinoembryonic antigen (CEA), have been proposed in order to identify poor prognostic factors providing beneficial adjuvant chemotherapy for stage I NSCLC patients. Some studies showed that the strong poor prognostic factors in these patients are IVI and ILI [1, 5–7]. The purpose of this study is to identify prognostic factors associated with poor prognosis in overall survival in completely resected N0 NSCLC patients. 2. Patients and Methods
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