Survival after limited resection for non-small cell lung cancer in poor-risk patients

Abstract

We studied 70 patients undergoing limited operation for non-small cell lung cancer on long-term survival and local recurrence to clarify the validity and indication of this procedure. We had thought these patients unable to tolerate standard operation (lobectomy or pneumonectomy) because of their reduced cardiopulmonary functional reserve, age, request for preservation of quality of life, and so on. Of the 70 consisting of 25 squamous cell carcinomas, 41 adenocarcinoma, and 4 large cell carcinomas, 63 patients had clinical stage I disease, 3 patients stage II disease, 4 patients stage III disease. Overall 5-year survival was 50.5% for clinical stage I. In this stage patients with lesions less than 30 mm in diameter had a significantly better prognosis (5-year survival : 57.8% for ≤30 mm versus 38.0% for > 30 mm, p = 0.0087, Breslow-Gehan-Wilcoxon test). Segmentectomy led to some survival advantage compared to partial resection (5-year survival : 63.0% for segmentectomy versus 44.0% for partial resection, p = 0.1276). No significant difference in survival rate existed between squamous cell carcinoma and adenocarcinoma (5-year survival : 49.2% for squamous cell carcinoma versus 56.2% for adenocarcinoma, p = 0.4184). Over 5-year survival has not been observed in cases with clinical stage II, IIIA, IIIB, or large cell carcinoma. Forty-seven of 70 patients were identified on the presence or absence of local recurrence. Eighteen patients had squamous cell carcinoma, 26 patients adenocarcinoma and 3 patients large cell carcinoma. An original tumor over 20 mm in diameter or a shorter free margin (length from the edge of the original tumor to the resected surface) than 20 mm increased the local recurrence rate. The adenocarcinoma group had a significantly higher local recurrence rate than that of the squamous cell carcinoma group (11.1% for squamous cell carcinoma versus 42.3% for adenocarcinoma, p = 0.0427, Fisher's exact test). All three cases of large cell carcinoma developed local recurrence. We suggest that limited operation for non-small cell carcinoma seems effective for poor risk patients, especially with clinical stage I squamous cell carcinoma or adenocarcinoma although a sufficient free margin is essential. And we consider that a conservative resection for a non-compromised patient with clinical stage I non-small cell lung cancer needs at least the tumor being less than 20 mm in diameter and the assurance of a free margin longer than 20 mm with more strict criteria in case of adenocarcinoma.