Prognostic factors and survival in patients undergoing surgery for T4 nonsmall cell lung carcinoma

Surgical treatment of T4 non-small cell lung carcinoma (NSCLC) is controversial. Between 1998 and 2011, 70 patients undergoing pulmonary resection for T4 NSCLC were evaluated. The patients were divided into four groups: the large vessels group (n = 28), the carinal group (n = 20), the separate tumor...

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Bibliographic Details
Published in:Acta chirurgica belgica 2014-01, Vol.114 (1), p.17-24
Main Authors: Citak, N, Büyükkale, S, Sayar, A, Metin, M, Pekçolaklar, A, Gürses, A
Format: Article
Language:English
Subjects:
Carcinoma, Non-Small-Cell Lung - diagnosis
Carcinoma, Non-Small-Cell Lung - mortality
Carcinoma, Non-Small-Cell Lung - surgery
Female
Humans
Lung Neoplasms - mortality
Lung Neoplasms - pathology
Lung Neoplasms - surgery
Male
Middle Aged
Neoplasm Staging
Pneumonectomy
Prognosis
Retrospective Studies
Survival Rate - trends
Turkey - epidemiology
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Summary:Surgical treatment of T4 non-small cell lung carcinoma (NSCLC) is controversial. Between 1998 and 2011, 70 patients undergoing pulmonary resection for T4 NSCLC were evaluated. The patients were divided into four groups: the large vessels group (n = 28), the carinal group (n = 20), the separate tumor nodules group (n = 13) and the mediastinal fat group (n = 9). Overall mortality and morbidity were 12.9% (n = 9) and 35.7% (n = 25), respectively and there was no significant differences between the four groups (p = 0.961, p = 0.750). Complete resection was possible in 47 patients (67.1%). The pathological nodal status was as follows: N0/1 in 58 patients and N2 in 12 patients. Five-year survival rate was 28.9% for all patients and 49.6%, 18.5%, 0% and 20.5% in the carinal, large vessels, mediastinal fat and separate tumor nodule groups, respectively. The carinal group was significantly different from the other groups in terms of survival (p = 0.05). By multivariate analysis, only two factors significantly and independently influenced survival: nodal status (N0/N1 versus N2; p = 0.01) and complete resection (R0 versus R1; p = 0.06). Resection is not a suitable approach for T4 NSCLC patients with N2 disease or incomplete resection. Resectable T4 NSCLC patients with carinal or tracheal involvement have better survival than do other T4 sub-groups.
ISSN:0001-5458