Predictors of Extra-Pulmonary Metastatic Disease in Patients with Recurrent Lung Cancer

Abstract Background: Lung cancer is one of the leading causes of cancer-related mortality worldwide. Its poor prognosis is associated with late detection and high recurrence rates. We aimed to determine if certain imaging characteristics of lung cancer recurrence were predictors of extra-pulmonary metastatic disease.Methods: We conducted a retrospective study of all patients at our institution with lung cancer recurrence detected on post-treatment imaging between January 2014-October 2019. Research ethics board approval was obtained. Included patients underwent pre-treatment imaging, surgical resection, and post-treatment imaging. Imaging characteristics and pathological findings of the pulmonary lesions were analyzed. Univariate logistic regression was performed to assess for potential predictors of extra-pulmonary metastatic disease. The variables evaluated were age, gender, original and recurrent lesion size and imaging characteristics, recurrence location, presence of chest wall or mediastinal invasion, lymphadenopathy, and malignancy subtype. Results: 76 patients were included (33 males; mean age 70.9, standard deviation [SD] 7.7). The primary lesions were adenocarcinoma (N=50), squamous cell carcinoma (N=21), and other (N=5). The mean time to recurrence was 24.3 months (SD=18.8) from date of surgical excision. The two significant predictors of extra-pulmonary metastatic disease were: having >1 recurrent lesion (odds ratio [OR], 8.1; p=0.004), and the presence of suspicious lymphadenopathy at the time of recurrence (OR, 14.1; p<0.001).Conclusion: In lung cancer recurrence, the presence of >1 recurrent lesion and suspicious lymphadenopathy at the time of recurrence were significant predictors of extra-pulmonary metastatic disease. These findings may help guide the risk stratification and management of patients with recurrent lung cancer.