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Right arrow Lung - cancer

Ann Thorac Surg 2002;73:1065-1070
© 2002 The Society of Thoracic Surgeons

Original article: general thoracic

Stage I non-small cell lung cancer: a pragmatic approach to prognosis after complete resection

Pascal Thomas, MD, FECTS*a,d, Christophe Doddoli, MDa, Xavier Thirion, MDb, Olivier Ghez, MDa, Marie-José Payan-Defais, MDc, Roger Giudicelli, MDa, Pierre Fuentes, MDa

a Department of Thoracic Surgery and Lung Transplantation, Ste Marguerite Hospital, University Méditerranée (Aix-Marseille II), School of Medicine, Marseille, France
b Department of Medical Information and Biostatistics, Ste Marguerite Hospital, University Méditerranée (Aix-Marseille II), School of Medicine, Marseille, France
c Department of Pathology, Ste Marguerite Hospital, University Méditerranée (Aix-Marseille II), School of Medicine, Marseille, France
d UPRES EA, IFR Jean Roche, Marseille, France

Accepted for publication November 28, 2001.

* Address reprint requests to Dr Thomas, Department of Thoracic Surgery and Lung Transplantation, Ste Marguerite Hospital-CHU Sud, 270 Bd Ste Marguerite, 13274 Marseille Cedex 9, France
e-mail: pathomas{at}ap-hm.fr

Background. Long-term results of the surgical treatment of stage I non-small cell lung cancer (NSCLC) are disappointing.

Methods. Univariate and multivariate analyses were conducted on 515 consecutive lung resections for stage I NSCLC performed from 1990 to 1999 and identified by reviewing a database into which data were entered prospectively. Tumors were staged as stages IA (n = 147) and IB (n = 348) according to the 1997 UICC (Union Internationale Contre le Cancer) pTNM classification.

Results. Operative mortality rates were 6.2%, 5.3%, 2.3%, and 0% for pneumonectomy, bilobectomy, lobectomy, and lesser resections, respectively. Overall survival rate was 61.1% (55.8% to 66.5%) at 5 years. Univariate analysis identified three significant adverse prognosticators: arteriosclerosis as comorbidity, pathologic T2 status, and blood vessel invasion. Male sex (p = 0.056) and performance of pneumonectomy (p = 0.057) were at the threshold of statistical significance. At multivariate analysis, three independent prognosticators entered the model: arteriosclerosis, blood vessels invasion, and performance of pneumonectomy.

Conclusions. Long-term survival of patients with completely resected stage I NSCLC was adversely influenced in a relatively balanced way by factors related to the clinical status of the patient, to the tumor, and to the treatment.




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