Original article: general thoracic
Histological determinants of survival in completely resected T1-2N1M0 nonsmall cell cancer of the lung

https://doi.org/10.1016/j.athoracsur.2003.08.080Get rights and content

Abstract

Background

The histologic determinants of survival after surgical resection of stage II nonsmall cell lung cancer are poorly understood. We analyzed the prognostic significance of a number of histologic features after complete resection of T1-2N1M0 nonsmall cell cancer of the lung.

Methods

The case notes and histology of all patients who underwent a potentially curative surgical resection for T1-2N1M0 nonsmall cell carcinoma of the lung between 1991 and 1997 were reviewed retrospectively. The following histologic factors were recorded: histologic type of tumor; number of nodes with metastatic deposits together with their nodal station; the presence of vascular invasion, visceral pleural involvement, and cellular necrosis; and grade of tumor. The results from 98 patients were analyzed. Univariate and multivariate analyses were performed to identify prognostic factors.

Results

Univariate analysis showed that only three factors had a statistically significant correlation with a poor prognosis: vascular invasion (p = 0.002), nonsquamous histology (p = 0.005), and visceral pleural involvement (p = 0.002). Multivariate analysis revealed that all three factors were significant independent adverse prognostic indicators.

Conclusions

Visceral pleural involvement, nonsquamous histology, and vascular invasion are all significant adverse prognostic factors after surgical resection of T1-2N1M0 nonsmall cell cancer of the lung. These findings conflict with previously published reports, and we advocate a prospective, large-scale study in order to clarify the prognostic significance of histologic characteristics in stage II disease.

Section snippets

Patients and methods

The case notes of all patients who underwent a surgical resection for nonsmall cell lung cancer between January 1991 and December 1997 at Nottingham City Hospital were reviewed retrospectively. All operations were performed by the same team of four thoracic surgeons who used similar preoperative and postoperative management. None of these patients underwent any preoperative or postoperative chemotherapy or radiotherapy. Before thoracotomy, all patients underwent an assessment for fitness for

Patient and tumor characteristics

Of the 98 patients, 64 were male and 24 were female with a mean age of 61.8 years (range, 45 to 78). Fifty-eight patients underwent a pneumonectomy, and 40 underwent either a lobectomy, bilobectomy, or sleeve lobectomy. A summary of the histologic characteristics of the specimens is shown in Table 1. Details of the patients' nodal involvement are listed in Table 2.

Univariate analysis

Of the 98 potentially curative lung resections, a total of 43 patients survived for a 5-year period after operation, representing

Comment

Under the TNM-based staging system for nonsmall cell lung cancer T1N1ML0, T2N1ML0, and T3N0ML0 tumors are jointly classified as stage II disease, with a further subdivision into stage IIA (for T1 tumors) and stage IIB (for T2 and T3 tumors) [15]. Although this staging system provides an anatomical classification of lung tumors, its secondary purpose is to allow the prognostic stratification of patients into homogenous groups after surgery 15, 16. Our study, however, in common with previously

Acknowledgements

The authors would like to thank Lynda Beggs for her assistance with data collation and analysis. In addition, we gratefully acknowledge the contribution of Fayek Salama in the management of these patients.

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