Background: Population-based estimates of absolute risk of lung cancer recurrence and of mortality CAL-130 rates after recurrence can inform clinical management. of lung cancer. In stage I the probability of dying within the first year after diagnosis was 2.7% but it was 48.3% within first year after recurrence; in stage IV the probabilities were 57.3% and 80.6% respectively. Over half the patients died within one year of first metastasis. Although in stages IA to IB about one-third of patients had a CAL-130 recurrence stage IIA patients had a recurrence risk (61.2%) similar to stage IIB (57.9%) and IIIA (62.8%) patients. Risk of brain metastases in stage IA to IIIA surgically treated non-small cell lung cancer patients increased with increasing tumor grade. Absolute risk of recurrence was virtually identical in adenocarcinoma and squamous cell carcinoma patients. Conclusions: This population-based study provides clinically useful estimates of risks of lung cancer recurrence and mortality that are applicable to the general population. These data highlight the need for more effective adjuvant treatments overall and within specific subgroups. The estimated risks of various endpoints are useful for designing clinical trials whose power depends on absolute numbers of events. Lung cancer is the leading cause of cancer deaths worldwide (1). The American Cancer Society estimated that 159260 Americans will die of it in 2014 (2). Up to 70% of surgically treated stage IA lung cancer patients are alive five years later compared with 2% to 13% with stage IV disease (3 4 Surgical resection strongly impacts survival and it is routinely performed for stage I II and selected stage III lung cancer patients. Nevertheless 30 to 70% of postoperative lung cancer patients develop one or more recurrent lesions and another 2% to 5% of patients have a second tumor of the lung (5 6 Patients whose lung cancers have spread locally or systemically when first detected constituting 70% of all patients (7-9) usually receive chemotherapy and/or radiation therapy instead of surgery. Local extension and metastases are primary causes of death in lung cancer patients. Identifying subsets of patients at high risk for recurrence and mortality following recurrence Mouse monoclonal to CD19 may lead to interventions that improve survival. Reliable data are needed to help clinicians understand recurrence risk in various patient subgroups which would require large studies with well-defined methods and follow-up (10). We therefore investigated overall CAL-130 survival recurrence rates and patterns and mortality following recurrence in population-based data from the Environment And Genetics in Lung cancer Etiology (EAGLE) study (11). EAGLE was conducted from 2002 to 2005 in the Lombardy region of Italy where over nine million people were served by a network of modern hospitals and health services with universal coverage. We estimated incident recurrence rates to various sites by stage and other clinical characteristics and the absolute risk (sometimes called crude risk or cumulative incidence) of recurrences by taking into account competing risks (12). Absolute risk is useful for clinical management because the chance of having a recurrence is in fact reduced by the risk of mortality before recurrence. To our knowledge this is the first population-based study to examine absolute risk of recurrence in lung cancer. Finally we quantified the probability CAL-130 of dying following recurrence and the impact of the site of recurrences on subsequent death rates. Methods The EAGLE study enrolled 2098 (84.8%) of the 2473 patients with lung cancer diagnosed from April 22nd 2002 to February 28th 2005 in the defined catchment area including 216 municipalities within Lombardy. To CAL-130 verify whether enrolled patients were similar to those who refused to participate we compared their distributions by CAL-130 age sex and area of residence (Supplementary Table 1 available online). Women and patients age 65 years and older refused participation more than men or younger patients. Because we enrolled the large majority of cases however our study cases were only slightly enriched in men (78.6%) compared with 77.8% of all case patients and only slightly enriched in those younger than age 65 years (38.8%) compared with 36.6% of all case patients. Thus the enrolled patients.