Abstract
BACKGROUND: Survival following pulmonary resection for primary lung cancer is considered to be principally dependent on the clinical stage of the disease. A study was undertaken to verify this and to identify other contributing factors. METHODS: The case records of all patients who underwent surgery for lung cancer over a two year period between January 1987 and December 1988 were reviewed retrospectively. RESULTS: One hundred and forty-seven lobectomies and 60 pneumonectomies were performed with 2.8% and 5.3% operative mortality, respectively. Squamous carcinoma was the commonest pathology (60%) followed by adenocarcinoma (30%). The overall five year survival was 45.5% (95% CI 44.1% to 57.9%). There were 123 patients with stage I disease, 40 with stage II, and 37 in stage IIIa with five year survival of 59.4% (95% CI 50.8% to 68%), 30% (95% CI 15.9% to 44.1%), and 16.2% (95% CI 3.5% to 31%), respectively. There were no differences in survival with respect to sex, extent of resection, or cell type. In patients with stage II disease the five year survival of those with T1 lesions (50%, 95% CI 37.3% to 62.9%) was better than those with T2 (28.1%, 95% CI 16.9% to 39.3%). Of eight patients over the age of 70 with stage IIIa disease none survived more than 24 months. CONCLUSIONS: Stage at operation is the most accurate predictor of long term survival in early lung cancer and surgery remains an effective treatment, particularly in stage I and II disease. Further study is needed to assess the prognostic value of subdividing stage II disease into T1 and T2 lesions. Major resection for locally advanced disease in older patients may be relatively ineffective.
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- Astudillo J., Conill C. Role of postoperative radiation therapy in stage IIIa non-small cell lung cancer. Ann Thorac Surg. 1990 Oct;50(4):618–623. doi: 10.1016/0003-4975(90)90200-p. [DOI] [PubMed] [Google Scholar]
- Breyer R. H., Zippe C., Pharr W. F., Jensik R. J., Kittle C. F., Faber L. P. Thoracotomy in patients over age seventy years: ten-year experience. J Thorac Cardiovasc Surg. 1981 Feb;81(2):187–193. [PubMed] [Google Scholar]
- Cybulsky I. J., Lanza L. A., Ryan M. B., Putnam J. B., Jr, McMurtrey M. M., Roth J. A. Prognostic significance of computed tomography in resected N2 lung cancer. Ann Thorac Surg. 1992 Sep;54(3):533–537. doi: 10.1016/0003-4975(92)90449-e. [DOI] [PubMed] [Google Scholar]
- Harviel J. D., McNamara J. J., Straehley C. J. Surgical treatment of lung cancer in patients over the age of 70 years. J Thorac Cardiovasc Surg. 1978 Jun;75(6):802–805. [PubMed] [Google Scholar]
- Martini N., Kris M. G., Flehinger B. J., Gralla R. J., Bains M. S., Burt M. E., Heelan R., McCormack P. M., Pisters K. M., Rigas J. R. Preoperative chemotherapy for stage IIIa (N2) lung cancer: the Sloan-Kettering experience with 136 patients. Ann Thorac Surg. 1993 Jun;55(6):1365–1374. doi: 10.1016/0003-4975(93)91072-u. [DOI] [PubMed] [Google Scholar]
- Martini N. Surgical treatment of lung cancer. Semin Oncol. 1990 Aug;17(4 Suppl 7):9–10. [PubMed] [Google Scholar]
- Naruke T., Goya T., Tsuchiya R., Suemasu K. Prognosis and survival in resected lung carcinoma based on the new international staging system. J Thorac Cardiovasc Surg. 1988 Sep;96(3):440–447. [PubMed] [Google Scholar]
- Naruke T., Goya T., Tsuchiya R., Suemasu K. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg. 1988 Dec;46(6):603–610. doi: 10.1016/s0003-4975(10)64717-0. [DOI] [PubMed] [Google Scholar]
- Naruke T., Suemasu K., Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg. 1978 Dec;76(6):832–839. [PubMed] [Google Scholar]
- Rosell R., Gómez-Codina J., Camps C., Maestre J., Padille J., Cantó A., Mate J. L., Li S., Roig J., Olazábal A. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med. 1994 Jan 20;330(3):153–158. doi: 10.1056/NEJM199401203300301. [DOI] [PubMed] [Google Scholar]
- Roth J. A., Fossella F., Komaki R., Ryan M. B., Putnam J. B., Jr, Lee J. S., Dhingra H., De Caro L., Chasen M., McGavran M. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl Cancer Inst. 1994 May 4;86(9):673–680. doi: 10.1093/jnci/86.9.673. [DOI] [PubMed] [Google Scholar]
- Roxburgh J. C., Thompson J., Goldstraw P. Hospital mortality and long-term survival after pulmonary resection in the elderly. Ann Thorac Surg. 1991 May;51(5):800–803. doi: 10.1016/0003-4975(91)90130-i. [DOI] [PubMed] [Google Scholar]
- Shields T. W. The significance of ipsilateral mediastinal lymph node metastasis (N2 disease) in non-small cell carcinoma of the lung. A commentary. J Thorac Cardiovasc Surg. 1990 Jan;99(1):48–53. [PubMed] [Google Scholar]
- Watanabe Y., Shimizu J., Oda M., Hayashi Y., Iwa T., Nonomura A., Kamimura R., Takashima T. Proposals regarding some deficiencies in the new international staging system for non-small cell lung cancer. Jpn J Clin Oncol. 1991 Jun;21(3):160–168. [PubMed] [Google Scholar]
- Watanabe Y., Shimizu J., Oda M., Hayashi Y., Watanabe S., Tatsuzawa Y., Iwa T., Suzuki M., Takashima T. Aggressive surgical intervention in N2 non-small cell cancer of the lung. Ann Thorac Surg. 1991 Feb;51(2):253–261. doi: 10.1016/0003-4975(91)90797-t. [DOI] [PubMed] [Google Scholar]
- Yashar J., Weitberg A. B., Glicksman A. S., Posner M. R., Feng W., Wanebo H. J. Preoperative chemotherapy and radiation therapy for stage IIIa carcinoma of the lung. Ann Thorac Surg. 1992 Mar;53(3):445–448. doi: 10.1016/0003-4975(92)90266-7. [DOI] [PubMed] [Google Scholar]
- van Klaveren R. J., Festen J., Otten H. J., Cox A. L., de Graaf R., Lacquet L. K. Prognosis of unsuspected but completely resectable N2 non-small cell lung cancer. Ann Thorac Surg. 1993 Aug;56(2):300–304. doi: 10.1016/0003-4975(93)91164-i. [DOI] [PubMed] [Google Scholar]