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Ann Thorac Surg 2005;80:1026-1027
© 2005 The Society of Thoracic Surgeons

Original article: General thoracic

Invited commentary

Hans G. Fieguth, MD

Department of Cardiothoracic Surgery, Klinikum der Johan Wolfgang Goethe Universitat, Frankfurt am Main, 60 590 Germany

(Email: fieguth{at}em.uni-frankfurt.de).


   Introduction
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 Introduction
The Society of Thoracic...
 References
 
The article by Birim and coworkers [1] evaluates treatment options for these patients by a retrospective analysis of a single center experience covering more than a decade.

Severe limitations are associated this approach, but a number of findings warrant further investigation and could affect clinical practice. First, patient distribution needs to be mentioned, with approximately 25% of patients with stage I or II nonsmall cell lung cancer (NSCLC) not undergoing surgery, mainly for functional reasons, especially insufficient predicted pulmonary reserve. Because neither lung function, represented by forced expiratory volume in 1 second, nor comorbidity, expressed as CCI score, proved to be independent risk factors for survival in the total study population, this high percentage should be challenged. A second finding, the low survival rates in the nonsurgical patients, highlights this problem. Although only patients with stage I or II NSCLC were studied, survival rates in this group were only 21% after 2 years and 3% after 5 years. Radiotherapy increased these values to 40% at 2 years and 8% at 5 years, which were still disappointing outcomes for a potentially curable disorder. A third problem is indicated by the surgical survival rates of 71% at 2 years and 50% at 5 years, that compare not favorably with well-defined study populations of similar disease stages and that reproduce the poor results of unbiased cancer register studies. Although no disease-specific survival rates were given in the study, these numbers emphasize the need to search for effective adjuvant approaches to improve long-term survival even in early stages of NSCLC. A last concern is associated with the poor measures for staging the patients, especially in the nonsurgical group. Computed tomographic scan diagnosis of nodal disease without histologic confirmation by mediastinoscopy or thoracoscopy causes false positive results and consecutive upstaging in as much as 30% of patients, which is another feature that distinguishes these unselected patients from study populations.

This retrospective and therefore limited summary of clinical experience indicates that even in an unselected patient group with early stages of NSCLC in which surgical therapy is the treatment of choice, serious problems remain and results need improvement to challenge current strategies.


   The Society of Thoracic Surgeons: Forty-Second Annual Meeting
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 Introduction
 The Society of Thoracic...
References
 
Please mark your calendars for the Forty-Second Annual Meeting of The Society of Thoracic Surgeons, to be held in New Orleans, Louisiana, from January 30–February 1, 2006. The program will provide in-depth coverage of thoracic surgical topics selected to enhance and broaden the knowledge of cardiothoracic surgeons. Attendees will benefit from traditional Abstract Presentations, as well as Surgical Forums, Breakfast Sessions, Surgical Motion Pictures, and Town Hall Meetings on specific topics.

Advance registration forms, hotel reservation forms, and details regarding transportation arrangements, as well as the complete meeting program, will be mailed to Society members this fall. Also, complete meeting information will be available on the Society’s Web site at www.sts.org. Nonmembers who wish to receive information on the Annual Meeting may contact the Society’s secretary, Douglas E. Wood.

Douglas E. Wood, MD

Secretary

The Society of Thoracic Surgeons

633 N. Saint Clair St, Suite 2320

Chicago, IL 60611-3658

Telephone: (312) 202-5800

Fax: (312) 202-5801

e-mail: mailto:sts{at}sts.org

website: www.sts.org


   References
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 Introduction
 The Society of Thoracic...
 References
 

  1. Birim Ö, Kappetein AP, Goorden T, van Klareren RJ, Bogers AJJC, et al. Proper treatment selection may improve survival in patients with clinical early-stage nonsmall cell lung cancer Ann Thorac Surg 2005;80:1021-1027.[Abstract/Free Full Text]




This Article
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