INCIDENCE OF LOCAL RECURRENCE AND 2ND PRIMARY TUMORS IN RESECTED STAGE-I LUNG-CANCER

From 1973 to 1985, 598 patients underwent resection for stage I non-sm all-cell lung cancer. There were 291 T1 lesions and 307 T2 lesions. Th e male/female ratio was 1.9:1. The histologic type was squamous carcin oma in 233 and nonsquamous carcinoma in 365. Lobectomy was performed i n 511 patients (85%), pneumonectomy in 25 (4%), and wedge resection or segmentectomy in 62 (11%). A mediastinal lymph node dissection was ca rried out in 560 patients (94%) and no lymph node dissection in 38 (6% ). Fourteen postoperative deaths occurred (2.3%). Ninety-nine percent of the patients were observed for a minimum of 5 years or until death with an overall median follow-up of 91 months. The overall 5- and 10-y ear survivals (Kaplan-Meier) were 75% and 67%, respectively. Survival in patients with T1 N0 tumors was 82% at 5 years and 74% at 10 years c ompared with 68% at 5 years and 60% at 10 years for patients with T2 t umors (p < 0.0004). The overall incidence of recurrence was 27% (local or regional 7%, systemic 20%) and was not influenced by histologic ty pe, Second primary cancers developed in 206 patients (34%). Of these, 70 (34%) were second primary lung cancers. Despite complete resection, 31 of 62 patients (50%) who had wedge resection or segmentectomy had recurrence. Five- and 10-year survivals after wedge resection or segme ntectomy were 59% and 35%, respectively, significantly less than survi vals of those undergoing lobectomy (5 years, 77%; 10 years, 70%). The 5- and 10-year survivals in the 38 patients who had no lymph node diss ection were reduced to 59% and 32%, respectively. Apart from the favor able prognosis observed in this group of patients, three facts emerge as significant: (1) Systematic lymph node dissection is necessary to e nsure that the disease is accurately staged; (2) lesser resections (we dge/segment) result in high recurrence rates and reduced survival rega rdless of histologic type; and (3) second primary lung cancers are pre valent in long-term survivors.