Original article: general thoracic
Surgical resection of multifocal non-Small cell lung cancer is associated with prolonged survival

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
https://doi.org/10.1016/S0003-4975(02)03878-XGet rights and content

Abstract

Background. Revisions in the international system for the staging of lung cancer, adopted in 1997, assigned the T4 descriptor to separate tumor nodules in the same lobe and the M1 descriptor to tumor nodules in a different lobe. Consequently, these changes shifted the stage of patients with these lesions to stage IIIB or stage IV. The goal of this review was to determine the impact of multifocal non-small cell lung cancer on survival.

Methods. A database analysis of our cardiothoracic surgery tumor registry was performed to identify all patients who underwent surgical resection of non-small cell lung cancer (NSCLC), who were ultimately determined to have pathologically node-negative disease from 1994 to 1999. All pathology reports were individually reviewed. Survival data were collected on each patient from the date of surgery with a mean duration of follow-up of 46.3 months. Kaplan Meier actuarial survival was determined for all patients.

Results. Forty-four patients were identified who underwent complete resection of multiple NSCLC tumors. During this same period, 504 patients underwent complete resection of stage I NSCLC tumors. The 3-year actuarial survival for patients with T1/N0/M0 tumors was 79.6%. In comparison with patients with T1/N0/M0 tumors, the 3-year actuarial survival rates of patients with T2/N0/M0 tumors (72.3%, p = 0.056), T4/N0/M0 tumors (66.5%, p = 0.058), and T1 to T2/N0/M1 tumors (63.6%, p = 0.201) were lower. However, these differences did not achieve statistical significance.

Conclusions. Although there was a trend toward decreased survival in patients with multifocal NSCLC compared with patients with stage I NSCLC, this did not achieve statistical significance. Importantly, survival in these subgroups of patients with stage IIIB or stage IV disease (stage determined solely on the basis of multifocal NSCLC) is better than the survival reported in the series that formed the foundation for these staging changes. These data support complete surgical resection of multifocal lung tumors in patients with node-negative NSCLC.

Section snippets

Population under study

A database analysis of our cardiothoracic surgery tumor registry was performed. Five hundred forty-eight patients underwent surgical resection of NSCLC with pathologically node-negative disease from January 1, 1994 to December 31, 1999. The surgical pathology reports of all patients identified by this database query were individually reviewed and the final pathologic staging was assigned using the 1997 revisions in the International System for Staging Lung Cancer. Patients with pathologically

Patient demographics

Five hundred forty-eight patients underwent complete surgical resection of NSCLC who were ultimately determined to have pathologically node-negative disease between January 1, 1994 and December 31, 1999 (Table 1). Two hundred eighty-eight patients were male (53%) and 260 patients (47%) were female. The mean age was 66.7 years old (± 9.8 years). The distribution of patients by pathologic stage was stage IA 273 (49.8%), stage IB 231 (42.2%), stage IIIA 27 (4.9%), and stage IV 17 (3.1%).

Comment

The optimal management of patients with multifocal non-small cell carcinoma remains controversial. Preoperatively, it is often difficult to determine if multiple lesions represent separate primary lung cancers or intrapulmonary metastases. This distinction can remain difficult even after pathologic examination of the surgical specimens when the histology of the lesions is the same. Martini and Melamed [7] described their experience with multifocal lung cancer and outlined their recommendations

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