Long-term survival in locally advanced non-small cell lung cancer invading the great vessels and heart

Abstract

Background: The aim of this study was to analyze the surgical outcomes of locally advanced lung cancer invading the great vessels or heart, according to the extension of cancer invasion.

Methods: From 1995 to 2015, 59 patients who were surgically treated and pathologically diagnosed with T4N0-1 non-small cell lung cancer with invasion to the great vessels or heart were enrolled. Surgical outcomes were compared between patient groups with and without intrapericardial invasion.

Results: The median age was 64 years (interquartile range [IQR] 57-68) and 56 patients (95%) were male. In-hospital mortality was 9% and median overall survival was 30 months (IQR 12-83). One and five-year overall survival rates were 75% and 44%, respectively. The median overall survival in patients with lung cancer invasion to the intrapericardial space (n = 45) was 27 months (IQR 10-63), while it was 42 months (IQR 18-104) in patients without intrapericardial invasion (n = 14). Median disease-free survival was significantly poorer in patients with intrapericardial invasion (12 months; IQR 6-55), especially in patients with heart invasion (n = 11, 7 months, IQR 5-27), than in patients without intrapericardial invasion (30 months, IQR 13-103).

Conclusion: Patients with lung cancer invading the intrapericardial space showed worse surgical outcomes in both overall and disease-free survival. Therefore, surgical management should be carefully considered in patients with intrapericardial invasion.

Keywords: Great vessel; heart; lung cancer; surgery.

Figure 1

Kaplan–Meier overall survival curve according to tumor location: (a) () left‐side cancer, and () right‐side cancer, intrapericardial invasion; (b) () no intrapericardial invasion, and () with intrapericardial invasion, and adjuvant chemotherapy; (c) () adjuvant chemotherapy, and () no adjuvant chemotherapy.

Figure 2

Kaplan–Meier overall survival curve according to the location of the tumor: (a) () left‐side cancer, and () right‐side cancer, intrapericardial invasion; (b) () no intrapericardial invasion, and () with intrapericardial invasion, and adjuvant chemotherapy; (c) () adjuvant chemotherapy, and () no adjuvant chemotherapy.

Figure 3

Nelson–Aalen cumulative hazard curves according to intrapericardial invasion: (a) () no intra‐pericardial invasion, and () with intra‐pericardial invasion, left atrial invasion; (b) () left atrial invasion, and () other sites and aortic invasion; (c) () aortic invasion, and () other sites.