We analyzed the background factors affecting the prognosis of resected primary lung cancer. A total of 156 cases of non-small cell lung cancer were surgically treated between 1984 and 1994 at Juntendo University Hospital. The histological types were as follows : adenocarcinoma 97 (62.2%), squamous cell carcinoma 50 (22.1%), adenosquamous carcinoma 5 (3.2%) and large cell carcinoma 4 (2.6%). The cumulative survival rate after operation was 79.9% in 1 year, 57.4% in 3 years and 50.0% in 5 years. The factors included in the present analysis were age, sex, performance status (PS), smoking history, history of double cancer, hemoglobin level, CEA level, histological type, T category, N category, M category, operative curability, type of resection, perioperative homologous blood transfusion and adjuvant chemotherapy using CDDP or CBDCA. Univariate analysis showed significant differences in survival in relation to PS, T category, N category, operative curability and type of resection. Multivariate analysis using Cox's proportional hazards model indicated that strong prognostic factors were N category, PS, histological type, age, T category and sex. These 6 features had a p-values less than 0.05. The type of resection and perioperative transfusion were marginally significant (0.05<p<0.1).
The relationship between N 2 disease and prognosis was also discussed. Of the 38 patients showed evidence of mediastinal lymph node involvement (N2 disease), 25 patients were dead and the median survival time was 17.5 months. The couse of death was recurrent lung cancer in 22 patients. The c-N staging had an influence on prognosis. Extensive and complete mediastinal lymph node dissection should be performed.
It is concluded that it is important to predict the high-risk group using prognostic factors. Postsurgical adjuvant therapy and careful follow-up is recommended to improve the survival rate especially in advanced cases.
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