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Ann Thorac Surg 1999;67:927-932
© 1999 The Society of Thoracic Surgeons
a Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan
Accepted for publication October 17, 1998.
Address reprint requests to Dr Suzuki, Division of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
e-mail: kjsuzuki{at}east.ncc.go.jp
Background. Management of patients with early-stage lung cancer but a poor prognosis is controversial.
Methods. Between January 1987 and December 1994, 365 patients with clinical stage I disease underwent surgical resection at our hospital. Eight preoperative clinical variables were entered into univariate and multivariate analyses to determine their impacts on 5-year survival.
Results. The 3-year and 5-year survival rates were 78.1% and 66.5%, respectively. In the multivariate analysis, clinical T2 status and preoperative high serum carcinoembryonic antigen levels were independent significant factors indicative of a poor prognosis (hazard ratio, 2.20 and 1.88, respectively). Patients with both of these factors had 3-year and 5-year survival rates of 65% and 38% (p < 0.001), and the risk of death for this subgroup was 4.14 times greater than that of the overall clinical stage I population.
Conclusions. A subgroup with clinical T2 disease and preoperative high serum carcinoembryonic antigen levels had a significantly poorer prognosis among patients with clinical stage I lung cancer. For this subgroup, a complete preoperative staging workup and multimodal therapy, especially induction chemotherapy, instead of surgical intervention alone could be beneficial.
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