Cancer 2013 May (2)-6

Surgical resection for non-small cell lung cancer: clinical features and outcomes for a consecutive series at an Irish tertiary referral centre.

Ir J Med Sci. 2013 Jun;182(2):217-25

Al-Alao BS, O’Callaghan DS, Gately K, Nicholson S, Coate LE, O’Connell F, McGovern E, O’Byrne KJ, Young VK.

Thoracic Oncology Research Group, St. James’s Hospital, Dublin 8, Ireland. bassel@doctors.org.uk

Abstract

BACKGROUND: Few patients diagnosed with lung cancer are still alive 5 years after diagnosis. The aim of the current study was to conduct a 10-year review of a consecutive series of patients undergoing curative-intent surgical resection at the largest tertiary referral centre to identify prognostic factors.

METHODS: Case records of all patients operated on for lung cancer between 1998 and 2008 were reviewed. The clinical features and outcomes of all patients with non-small cell lung cancer (NSCLC) stage I-IV were recorded.

RESULTS: A total of 654 patients underwent surgical resection with curative intent during the study period. Median overall survival for the entire cohort was 37 months. The median age at operation was 66 years, with males accounting for 62.7 %. Squamous cell type was the most common histological subtype, and lobectomies were performed in 76.5 % of surgical resections. Pneumonectomy rates decreased significantly in the latter half of the study (25 vs. 16.3 %), while sub-anatomical resection more than doubled (2 vs. 5 %) (p < 0.005). Clinico-pathological characteristics associated with improved survival by univariate analysis include younger age, female sex, smaller tumour size, smoking status, lobectomy, lower T and N status and less advanced pathological stage. Age, gender, smoking status and tumour size, as well as T and N descriptors have emerged as independent prognostic factors by multivariate analysis.

CONCLUSION: We identified several factors that predicted outcome for NSCLC patients undergoing curative-intent surgical resection. Survival rates in our series are comparable to those reported from other thoracic surgery centres.

PMID: 23139062

 

Author’s comments:

There is a lack of comprehensive data reporting risks associated with disease recurrence in the context of surgery for NSCLC in the Republic of Ireland. In order to compare the survival of our cohort with those of other large thoracic surgery centres, we performed a retrospective review to investigate the clinical characteristics and outcomes of a consecutive series of patients who underwent curative- intent surgery for NSCLC at our institution over a 10-year period. Survival data for this cohort are presented and the prognostic factors that influence outcome are defined.

The data presented here confirms that in carefully selected individuals, surgical intervention offers the best prospect of cure for NSCLC and survival rates in this series are similar to those reported from other international thoracic surgery centres. Although we have identified subgroups with less favourable charac- teristics, these patients should nevertheless be considered for surgery in the absence of contraindications, as survival after complete resection is better than that with other therapeutic strategies.

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