1 Relevance of an extensive follow-up after surgery for non-small cell lung cancer

Background: There are no international guidelines for an appropriate and cost-effective follow-up for resected non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed the outcome of NSCLC patients after curative surgery. Follow-up included physical examination and chest X-Ray every 3 months, chest CT-scan, bronchoscopy, abdominal ultrasound, brain CT-scan and bone-scan every 6 months for 3 years then every year during 2 years. Prognostic factors and costs were analysed. Results: Median overall survival (OS) following surgery for NSCLC in 162 patients was 38.5 months. Recurrence occurred in 85 patients (52.5%) including 41 symptomatic subjects (48%). Disease-free survival was similar between patients with asymptomatic recurrence vs symptomatic patients (11.4 vs. 12 months; p=0.41). Recurrence was detected by physical examination or chest X-ray in 47 patients (55.3%). Curative-intent therapy was provided in 18/44 (41%) patients with asymptomatic recurrence and in 4/41 (10%) symptomatic cases (p=0.001). Median OS from time of recurrence was higher in asymptomatic patients than in symptomatic patients (15.5 vs. 7.2 months; p=0.001). The cost per year of gained life was 32,700 USD (22,397€)