Abstract
Background: The aim of this retrospective study was to evaluate prognostic factors for recurrence-free
survival in stage-l non-small-cell bronchogenic carcinoma. Methods: During 9 years, 338 consecutive patients were operated on for stage-l bronchogenic
carcinoma. Patients with small-cell carcinoma (n = 14), prior malignancies in locations
other than pulmonary (n = 41), and patients with incomplete data on prognostic factors
(n = 11) were excluded. Of the remaining 272 patients 226 were men. Mean age was 63
years (40 to 81 years). The resections performed comprised 215 lobectomies and bilobectomies,
36 segmentectomies and wedge resections, and 21 pneumonectomies. According to the
number of sites of dissected Iymph nodes 3 subgroups were formed: group A with 0 to
4 (n = 71), B with 5 to 6 (n = 118), and C with 7 to 10 sites (n = 83). Median follow-up
was 46 months. Results: Three patients (1.1 %) died within 30 days of operation. In 3 patients the resection
was revealed to be not radical (R1). At the end of follow-up, 191 patients were alive,
174 of these without recurrence. Eighty-one patients had died, 53 associated with
tumor recurrence. Four patients had died of non-pulmonary malignancies. Twenty-two
patients died of causes not related to tumor disease. In 2 patients the cause of death
could not be determined retrospectively. Overall 5-year survival was 65% (95% confidence
interval [Cl] 58-72%), recurrence-free survival 59% (Cl 51 -66%). Significant prognostic
factors for recurrence-free survival were T stage (relative risk [RR] 1.7 for T2 vs
T1, Cl 1.0-3.0), age (RR 1.9 for > 70 years vs = 70 years, Cl 1.1 -3.1), adeno cell
type (RR 2.3 vs squamous cell, Cl 1.4-4.0), as well as lymphangiosis carcinomatosa
(RR 2.3, Cl 1.2-4.4). Extent of operative resection, extent of lymphadenectomy, and
sex did not influence survival. Conclusion: 5-year survival of our patients was in the range reported in literature. Most patients
died of distant metastases. Our retrospective study probably underestimated the occurrence
of second primary cancers of the lung. Limited resection in poor-risk patients showed
equivalent results to lobectomy. The extent of lymph-node resections had no influence
on survival of stage-l patients, however, it must be remembered that positive results
in lymph nodes shift patients to higher stages.
Key words
Stage I nonsmall cell carcinoma - Prognostic factors
