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: lung cancer, recurrence, resection, ALK rearrangement


Complete surgical resection is the most effective treatment in patients with non-small cell lung cancer (NSCLC). However, recurrence remains a major obstacle in curing NSCLC.1–5

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Most postoperative recurrences of NSCLC develop within 5 years after resection. Various studies have reported on the natural history of NSCLC within 5 years after resection; the prognostic factors after resection include pathologic stage, visceral pleural involvement, histology, vascular invasion, and need for pneumonectomy.6–8

However, ultra-late recurrence developing over 10 years after resection is extremely rare. There are few case reports on ultra-late recurrence, and it is not well documented or well understood.9–15 In this study, we aimed to examine the factors related to ultra-late recurrence.

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