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Ann Thorac Surg 2005;79:384
© 2005 The Society of Thoracic Surgeons

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Correspondence

Effects of Pneumonectomy on Survival of Patients With Stage I Lung Cancer

Allegheny General Hospital, Department of Cardiothoracic Surgery, 320 E North Ave, South Tower, 14th Floor, Pittsburgh, PA 15212, USA

tbirdas1{at}aol.com

To the Editor:

In their article on the outcomes of pneumonectomy for stage I nonsmall cell lung cancer, Alexiou and colleagues [1] conclude that "pneumonectomy for stage T1N0 or T2N0 nonsmall cell lung cancer has a potent, adverse impact on survival." Indeed this is a very interesting finding.

As the authors point out in the "Discussion" section, lack of information on disease recurrence and cause of death do not allow for more specific conclusions and generation of hypotheses regarding the reasons for the decreased survival in the pneumonectomy group.

Another interesting question is whether early or late survival rates are equally affected, particularly because the pneumonectomy patients experienced significantly higher perioperative mortality rates. Here the authors comment that "the survival difference continues to increase over the first 2 or 3 postoperative years [1]." However this is not evident from the data presented; in fact all three survival curves shown have overlapping 95% confidence intervals at 3 and 5 years. Perhaps an alternative way of presenting the data would be the use of hazard function analysis [2] or even simply excluding the perioperative deaths. Although the significance of the findings on overall mortality should not be underestimated, separating early and late components of the mortality risk is very important in our decision making and care of these patients.

References

1. Alexiou C, et al. Pneumonectomy for stage I (T1N0, and T2N0) nonsmall cell lung cancer has potent, adverse impact on survival. Ann Thorac Surg. 2003;76:1023–1028[Abstract/Free Full Text]
2. Blackstone EH. Outcome analysis using hazard function methodology. Ann Thorac Surg. 1996;61(Suppl 2):S2–7; discussion S33–4

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas J Birdas Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Birdas, T. J Search for Related Content PubMed Articles by Birdas, T. J Related Collections Lung - cancer Related Article