[Analysis of prognostic factors and efficacy of surgical treatment for non-small cell lung cancer: department of surgery NTLDRI (1998-1999)]

Abstract

Introduction: Surgical resection is the mainstay of curative treatment for non-small cell lung cancer.

Material and methods: A retrospective analysis of the efficacy of this treatment, based on 431 patients operated from 1998 to 1999 in the Department of Surgery of the National Tuberculosis and Lung Diseases Research Institute, was accomplished. In 218 cases (51%) lobectomy was performed, in 21 cases (5%) - bilobectomy, in 188 cases (44%) - pneumonectomy and in 4 cases (1%) - wedge resection. The pIA stage was diagnosed in 70 cases (16%), pIB - in 112 (26%), pIIA - in 22 (5%), pIIB - in 110 (26%), pIIIA - in 88 (20%), pIIIB - in 13 (3%) and pIV - in 16 (4%).

Results: The five-year survival rate for the whole group was 49.1%. Statistical analysis revealed better survival in patients younger than 50 (p = 0.03), in women (p = 0.01, HR = 0.63) and in cases with less extensive surgery, i.e. lobectomy, (p < 0.05). Long-term survival was significantly dependent on the disease stage (p < 0.005). Five-year survival of patients in stage IA was 81.7%, IB - 62.2%, IIA - 59.1%, IIB - 38%, IIIA - 21.3%, IIIB - 8.3% and IV - 8.3%. Tumour status (p < 0.005) and histological subtype (p < 0.005) had a significant influence on long-term survival. Five-year survival of patients with squamous cell carcinoma was 53.4%, with adenocarcinoma - 38.3%, with large cell carcinoma - 37.5%, with carcinoid - 94.7% and with other types of cancer - 39.1%. The decreased preoperative Hb level (p < 0.005, HR = 1.52), as well as blood transfusion in postoperative period (p = 0.03), were negative prognostic factors. Significantly worse prognosis was observed in the cases of R1 or R2 categories (p = 0.01) and M1 category (p < 0.005). Additionally, in multivariate Cox analysis, a decreased FEV1 lower than 80% (HR = 1.46) was a negative prognostic factor, and lack of symptoms, except cough (HR = 0.73), was a positive one.

Conclusions: Univariate analysis revealed several factors worsening prognosis: male sex, age older than 50 years, lowered preoperative Hb concentration, extended surgery, advanced stage, adenocarcinoma and large cell carcinoma, T status, N status, R status, M status and blood transfusion in postoperative period. In multivariate Cox analysis lowered preoperative Hb concentration, decreased FEV1 lower than 80% pred., extended surgery (pneumonectomy), advanced stage and adenocarcinoma were negative prognostic factors. Female sex and lack of symptoms, except coughing were positive prognostic factors.