Surgical Results in T2N0M0 Nonsmall Cell Lung Cancer Patients With Large Tumors 5 cm or Greater in Diameter: What Regulates Outcome?

Abstract

Background:We assessed the surgical results along with the clinical and biological features of non-small cell lung cancer (NSCLC) patients with localized large tumors. Methods:The study population consisted of 86 NSCLC patients who underwent complete resection of tumors 5 cm or larger in diameter in stage IB (T2N0M0). We immunohistochemically assessed the expression of angiostatin and endostatin. Results:The median tumor size was 6.0 cm (range, 5-14 cm). The operative procedures used were lobectomy in 71 cases, bilobectomy in 8 cases, and pneumonectomy in 11 cases. Fifty patients (58.1%) relapsed during the mean follow-up period of 33.6 ± 4.5 months. The median disease-free interval (DFI) was 9 months. Of 44 recurrent patients whose DFI could be identified, 25 patients (56.8%) relapsed within 12 months after the operation. The overall 5-and 10-year survival rates were 42.0% and 24.2%, respectively.Multivariate analysis showed that the degree of pleural involvement and angiostatin expression within the tumor were independent prognostic indicators. The endostatin expression within tumors also had a weaker relationship with outcome.Conclusions: Long-term surgical results were poor and early relapse was common in this cohort. In addition to pleural involvement, the tumor-induced expression of angiostatin and endostatin merit further investigation to gain possible insights into selection of patients who will benefit from surgery as the first line treatment.2

Prognostic impact of intratumoral vessel invasion in completely resected pathologic stage I non–small cell lung cancer

“…Pleural invasion status is well recognized as a strong prognostic factor. 9,10,15,22,24,25 Our study also confirmed pleural invasion as an independent predictor. Although the stage IB group could not be classified into groups with obviously different prognosis by IVI only, we found a worse prognosis in patients with stage IB with both IVI and pleural invasion than in patients without these factors.…”

Prognostic factors of tumor recurrence in completely resected non-small cell lung cancer

“…Visceral pleural invasion has been recognized to be another strong prognostic factor associated with increased risk of recurrence and death;5,13,23,27–30 however, some researchers have found otherwise,4 and our study did not find any correlation with tumor recurrence.…”

Surgical–pathologic factors affect long-term outcomes in stage IB (pT2 N0 M0) non–small cell lung cancer: A heterogeneous disease

“…In the current study, we divided the tumors into P0, P1, and P2 subgroups according to the depth of VPI. Using a similar classification, Ohta and colleagues 19 reported patients with P2 showed a significantly poorer survival and shorter disease-free interval than did patients with P0 and P1. Our patient cohort demonstrated an actual 5-year survival of 64.3% in the P0 group.…”