HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jeffrey L. Port Robert J. Korst Paul C. Lee Nasser K. Altorki Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Port, J. L. Articles by Altorki, N. K. Search for Related Content PubMed PubMed Citation Articles by Port, J. L. Articles by Altorki, N. K. Related Collections Lung - cancer Related Article

Ann Thorac Surg 2007;83:397-400
© 2007 The Society of Thoracic Surgeons

---

Original Articles: General Thoracic

Surgical Resection for Multifocal (T4) Non-Small Cell Lung Cancer: Is the T4 Designation Valid?

Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York

Accepted for publication August 10, 2006.

^_* Address correspondence to Dr Altorki, Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Suite M404, New York Presbyterian Hospital–Weill Medical College of Cornell University, 525 E 68th St, New York, NY 10021. (Email: nkaltork{at}med.cornell.edu).

BACKGROUND: The current international staging system for lung cancer designates intralobar satellites as T4 disease. In this study, we sought to determine the impact of multifocal, intralobar non-small cell lung cancer (NSCLC) on patient survival and its potential relevance to stage designation.

METHODS: We conducted a retrospective review of our thoracic surgical cancer registry from 1990 to 2005. Included were 53 patients with a resected lung cancer containing intralobar satellites detected preoperatively (n = 8) or in the resected specimen (n = 45). Patients with multicentric bronchioloalveolar cancer were excluded. All patients had an anatomic resection with mediastinal lymph node dissection. Median follow-up for the entire group was 31 months. Survival was calculated by the Kaplan-Meier method. A Cox proportional hazards regression model was performed to examine simultaneously the effects on overall survival of age, gender, nodal disease, number of satellite lesions, lymphatic invasion, and T status.

RESULTS: The median age of the 53 patients with multifocal, intralobar (T4) disease was 68 years and 31 were women. Ten patients had more than one satellite lesion. Overall 5-year survival was 47.6% (95% confidence interval [CI], 27.36% to 65.30%) for all patients with resected intralobar satellites. Patients without nodal metastases had a 5-year survival of 58.4% (95% CI, 28.76% to 79.30%). The Cox regression identified female gender (adjusted hazard ratio [HR], 0.31; 95% CI, 0.10 to 0.96; p < 0.04) as a significant prognostic variable but only a trend towards significance for nodal status (adjusted HR, 2.3; 95% CI, .83 to 6.26; p < 0.11).

CONCLUSIONS: Patients with intralobar multifocal NSCLC detected in the resected specimen have a more favorable prognosis after surgical resection than might be predicted by their stage T4 designation. Five-year survival rates, especially in T4N0 patients, more closely approximate those with stages IB or II NSCLC.

Related Article

Invited commentary

Jean Deslauriers
Ann. Thorac. Surg. 2007 83: 400-401. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				F. Farjah, D. E. Wood, T. K. Varghese Jr, R. G. Symons, and D. R. Flum Trends in the operative management and outcomes of T4 lung cancer. Ann. Thorac. Surg., August 1, 2008; 86(2): 368 - 374. [Abstract] [Full Text] [PDF]

				A. Oliaro, P. L. Filosso, A. Cavallo, R. Giobbe, C. Mossetti, P. Lyberis, R. C. Cristofori, and E. Ruffini The significance of intrapulmonary metastasis in non-small cell lung cancer: upstaging or downstaging? A re-appraisal for the next TNM staging system. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 438 - 443. [Abstract] [Full Text] [PDF]

				J. G. Lee, C. Y. Lee, D. J. Kim, K. Y. Chung, and I. K. Park Non-small cell lung cancer with ipsilateral pulmonary metastases: prognosis analysis and staging assessment Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 480 - 484. [Abstract] [Full Text] [PDF]

				D. Trousse, X. B. D'Journo, J.-P. Avaro, C. Doddoli, R. Giudicelli, P. A. Fuentes, and P. A. Thomas Multifocal T4 non-small cell lung cancer: a subset with improved prognosis Eur. J. Cardiothorac. Surg., January 1, 2008; 33(1): 99 - 103. [Abstract] [Full Text] [PDF]

				J. Deslauriers Invited commentary Ann. Thorac. Surg., February 1, 2007; 83(2): 400 - 401. [Full Text] [PDF]