N. Martini et al., INCIDENCE OF LOCAL RECURRENCE AND 2ND PRIMARY TUMORS IN RESECTED STAGE-I LUNG-CANCER, Journal of thoracic and cardiovascular surgery, 109(1), 1995, pp. 120-129
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.