Abstract
Prognostic factors were determined retrospectively in surgical patients with pathologically staged T3 lung cancer invading adjacent organs. Of 304 patients who underwent pulmonary resection for primary non-small cell lung cancer, 39 (13% ) had contiguous spread to a rib (n=16), the parietal pleura (n=13), the pericardium (n=7), or the diaphragm (n=3) and underwent en bloc resection. A complete resection was achieved in 33 cases (85%) . Five-year survival rates of patients who received complete versus incomplete resection were 33% and 20%, respectively (p<0.05) . Five-year survivals of patients whose cancer was detected by mass screening (n=8) and by tumor-related symptoms (n=25) were 73% and 33%, respectively, and the 3-year survival rate of patients whose cancer was detected incidentally during a work-up for another disease (n = 6) was 15% (p< 0.05) . The 5-year survival rate for patients with T3N0 lesions (n=22) was 47%, and the 3-year survival rate for those with T3N 1, 2 lesions (n=17) was 0% (p<0.01) . Five-year survival figures for squamous cell carcinoma (n=17) and adenocarcinoma (n=16) patients were 60% and 15%, respectively (p<0.05) . No patient with either adenosquamous cell carcinoma (n=2) or large cell carcinoma (n= 4) survived for longer than 3 years. Five-year survival rates following rib resection, parietal pleurectomy, or pericardial resection were 15%, 25%, and 75%, respectively. The 3-year survival rate after diaphrag-matic resection was 50%. The survival rate differences were significant (p< 0.05) between treatment by pericardial resection and rib resection or parietal pleurectomy, but not between the patients with rib resection and pleurectomy (p>0.05) . No patient who underwent first or second rib resection survived for longer than 3 years (n=6), while the 5-year survival rate after third or lower rib resection (n=10) was 22% (p<0.05) . Multivariate analyses revealed that the lymph node status (p<0.01) and site of invasion (p<0.05) to be significant prognostic factors for this patient group. In conclusion, lymph node status, histological type, invaded structures, and level of rib resection affected the survival rates for surgically treated patients with T3 primary lung cancer invading adjacent structures. Of these, lymph node status and level of rib resection significantly affected patient prognosis.
