The clinical, histopathologic, and biologic features of LCNELC are more similar to OLC than to SCLC. Therefore, LCNELC should continue to be classified and treated as a large cell carcinoma.

BACKGROUND: It is uncertain whether lymphadenectomy (LA) affects overall survival (OS) or disease‐free survival (DFS) rates for patients with stage I nonsmall cell lung cancer (NSCLC), as is the optimal number of lymph nodes that should be recovered. METHODS: There were 24,273 patients with stage I NSCLC diagnosed from 1992 to 2002 who were included in the Surveillance, Epidemiology, and End Results database and who underwent a definitive surgical procedure. Median follow‐up was 35 months. RESULTS: For the entire population, having LA was associated with an increase in the 5‐year OS rate from 41.6% to 58.4% (P<.0001) and in DFS from 58.0% to 73.09%, compared with not having LA. Outcome improved with increasing number of recovered lymph nodes, with a plateau at 11 or more lymph nodes. For patients diagnosed from 1998 to 2002 undergoing only N1 or only N2 dissections, LA was also associated with statistically significant improvements in OS in both groups and a significant difference and trend for improved DFS in the 2 groups, respectively. The maximum differences in both OS and DFS between those with no LA and those with LA occurred when 11 to 16 lymph nodes were removed for the former group or 7 to 10 lymph nodes for the latter group, respectively. CONCLUSIONS: LA was associated with increased rates of OS and DFS, compared with no LA. Our results also suggest the minimum number of recovered lymph nodes needed to see the maximum staging accuracy conferred by LA. Cancer 2009. © 2009 American Cancer Society.

BACKGROUND: This study assessed the impact of surgical, histopathologic and patient‐related factors on the risks of local and distant recurrence and overall survival for patients with stages I through IIIA nonsmall cell lung carcinoma (NSCLC) undergoing definitive resection with or without adjuvant chemotherapy. METHODS: This study included 373 consecutive patients treated between 2000 and 2005 who did not receive adjuvant or neoadjuvant radiotherapy, had at least 3 months of follow‐up, and did not have a history of other cancers within 5 years of the diagnosis of their NSCLC. Of these, 52% had pathologic stage IA disease, 30% had stage IB, 5% had stage IIA, 8% had stage IIB and 5% had stage III disease. Forty‐four patients received chemotherapy. RESULTS: The median follow‐up was 33 months. Local failure rates at 2 years, 3 years, and 5 years were 16%, 22%, and 32%, respectively; distant recurrence rates were 13%, 15%, and 21%, respectively. Multivariable analysis revealed that local recurrence was significantly associated with the presence of lymphatic or vascular invasion (LVI), the use of chemotherapy, and having diabetes; distant recurrence was significantly higher in patients with nonsquamous cell histology, those undergoing pneumonectomy, and those with more advanced TNM stage. Survival was significantly associated with age, history of myocardial infarction, performance of a pneumonectomy, histology, LVI, and the number of positive N1 lymph nodes. CONCLUSIONS: Local recurrence was the predominant type of failure in this series. Patient with diabetes or LVI may benefit from close surveillance and aggressive therapy of asymptomatic local recurrences, especially when chemotherapy is given in addition to surgery. Cancer 2009. © 2009 American Cancer Society.