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Original Articles: General Thoracic

Trends in the Operative Management and Outcomes of T4 Lung Cancer

^a Surgical Outcomes Research Center, University of Washington, Seattle, Washington
^b Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
^c Division of General Surgery, Department of Surgery, University of Washington, Seattle, Washington

Accepted for publication April 28, 2008.

^_* Address correspondence to Dr Flum, Department of Surgery, University of Washington, 1959 NE Pacific, Box 356410, Seattle, WA 98195-6310 (Email: daveflum{at}u.washington.edu).

Background: This study describes temporal trends and variables in the operative management and outcomes of patients with T4 lung tumors in the general community.

Methods: Surveillance, Epidemiology, and End-Results-Medicare data were used for a cohort study (1992 to 2002) of patients with stage IIIB lung cancer defined by T4 tumors. Patient characteristics, tumor size, nodal status, use of staging modalities, extent of resection, multi-modality therapy, and provider volume were examined. Follow-up death data were available through 2005.

Results: Among 13,077 cases of T4 lung tumors, 1177 patients (9%) underwent resection. Over time, use of mediastinoscopy (20%) did not change (p = 0.49); mediastinal lymphadenectomy increased from 10% to 29% (p < 0.001) and neoadjuvant therapy from 4% to 8% (p = 0.04). Five-year survival rates increased from 15% to 35% (p < 0.001). A higher hazard of death was associated with increasing age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00 to 1.03), comorbidity index of 3 vs 0 (HR, 1.66; 95% CI 1.24 to 2.21), tumor size 3 cm or more (HR, 1.55; 95% CI, 1.30 to 1.84), N2/N3 nodes (HR, 1.67; 95% CI, 1.40 to 1.98), and sublobar resection (HR, 1.55; 95% CI, 1.26 to 1.90). Mediastinal lymphadenectomy had a significantly lower hazard of death (HR, 0.78; 95% CI, 0.64 to 0.95). Improvements in overall survival over time persisted after adjustment for these factors (p = 0.007).

Conclusions: Temporal changes in the operative management of T4 tumors coincided with improvements in long-term survival. Our findings corroborate prior work and practice guidelines supporting operative therapy for select patients with T4 lung cancer.

Related Article

Invited Commentary

Lorenzo Spaggiari
Ann. Thorac. Surg. 2008 86: 375. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				F. Farjah, D. R. Flum, T. K. Varghese Jr, R. G. Symons, and D. E. Wood Surgeon Specialty and Long-Term Survival After Pulmonary Resection for Lung Cancer Ann. Thorac. Surg., April 1, 2009; 87(4): 995 - 1006. [Abstract] [Full Text] [PDF]

				L. Spaggiari Invited Commentary Ann. Thorac. Surg., August 1, 2008; 86(2): 375 - 375. [Full Text] [PDF]