Chest
Volume 117, Issue 2, February 2000, Pages 374-379
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Clinical Investigations
Prognostic Assessment of 2,361 Patients Who Underwent Pulmonary Resection for Non-small Cell Lung Cancer, Stage I, II, and IIIA

https://doi.org/10.1378/chest.117.2.374Get rights and content

Study objectives

Staging and classification in lung cancer are important for both patient management and clinical research. Results of survival after resection in patients with primary non-small cell lung cancer (NSCLC) are analyzed in order to validate recent refinements of the staging system.

Design

Retrospective study; period from 1970 to 1992; follow-up ≥ 5 years.

Patients

A total of 2,361 previously untreated patients who underwent resection for stage I, II, or IIIA primary NSCLC.

Measurements

Survival was estimated from the date of operation using the Kaplan-Meier survival analysis method. Deaths within 30 days of operation were excluded. Survival comparisons of different surgical-pathologic TNM classification (based on pathologic examination of resected specimens) as well as further discriminative factors were analyzed by log-rank test.

Results

Postoperative death occurred in 3.9% of patients. For survival analyses, 2,263 patients were included. The overall 5-year survival was 937/2,263 (41.4%). Five-year survival in stage IA was 255/404 (63%); in stage IB, 367/797 (46%); in stage IIA, 43/83 (52%); in stage IIB, 210/642 (33%); and in stage IIIA, 63/337 (19%). No significant difference in survival was demonstrated between stages IB and IIA. Until 4 years after surgery, age at operation did not influence survival; after 5 years, patients > 65 years old had a significantly lower survival.

Conclusion

The TNM staging system accurately reflects the prognosis in primary NSCLC, but some stage definitions can be discussed. Despite the fact that the staging system is built on clinical data, the present analysis, which includes postsurgical data, confirms the similar survival of patients with T2N0M0 and T1N1M0. These results also stress the use of two separate substages, especially because these patients are offered surgery when possible.

Section snippets

Materials and Methods

From 1970 through 1992, 2,799 patients underwent surgery for NSCLC, 2,559 of whom underwent resection. Of this latter group, 2,361 patients underwent resection for stage I, II, or IIIA primary NSCLC.1 None of the patients had received previous treatment for NSCLC. Staging definitions for the T (primary tumor), N (regional lymph nodes), and M (distant metastasis) components were used according to the International Staging System for Lung Cancer.1

Patient age ranged from 26 to 85 years, with a

Results

Within 30 days after surgery, 91 patients died (3.9%), 43 of whom patients had undergone pneumonectomy. Postoperative death was related not to disease stage but to the extension of the resection (7.2% for pneumonectomy; 5.4% for bilobectomy; 2.5% for lobectomy; 0.6% for small resections) and the patient's age (6.4% in elderly patients and 2.1% in patients aged < 65 years). Seven patients were lost to follow-up; therefore, 2,263 patients were included for survival analyses. Overall 5-year

Discussion

Lung cancer staging—based on anatomic extent of the disease and using the TNM classification system—is an important aid to determine the clinical course of the patient and the success of treatment.1, 2, 3, 8 For patients with NSCLC, surgery and complete removal of the primary tumor and its involved lymph nodes remains the most effective mode of treatment.9 The postresection survival of our patients with primary NSCLC of stages I, II, and IIIA is comparable to the survival reported by other

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