Results after surgery in stage-I bronchogenic carcinoma

Background: The aim of this retrospective study was to evaluate prognostic factors for recurrence-free survival in stage-1 non-small-cell bronchogenic carcinoma. Methods: During 9 years, 338 consecutive patients were operated on for stage-1 bronchogenic carcinoma. Patients with small-cell carcinoma (n = 14), prior malignancies in locations other than pulmonary (n = 41), an d patients with incomplete data on prognostic factors (n = 11) were exclude d. Of the remaining 272 patients 226 were men. Mean age was 63 years (40 to 81 years). The resections performed comprised 215 lobectomies and bilobect omies, 36 segmentectomies and wedge resections, and 21 pneumonectomies. Acc ording to the number of sites of dissected lymph nodes 3 subgroups were for med: group A with 0 to 4 (n = 71), B with 5 to 6 (n = 118), and C with 7 to 10 sites (n = 83). Median follow-up was 46 months. Results: Three patients (1.1 %) died within 30 days of operation. In 3 patients the resection was revealed to be not radical (R1). At the end of follow-up, 191 patients were alive, 174 of these without recurrence. Eighty-one patients had died, 53 a ssociated with tumor recurrence. Four patients had died of non-pulmonary ma lignancies. Twenty-two patients died of causes not related to tumor disease . In 2 patients the cause of death could not be determined retrospectively. Overall 5-year survival was 65 % (95 % confidence interval [CI] 58 - 72 %) , recurrence-free survival 59% (CI 51-66%). Significant prognostic factors for recurrence-free survival were T stage (relative risk [RR] 1.7 for T2 vs T1, CI 1.0-3.0), age (RR 1.9 for > 70 years vs less than or equal to 70 ye ars, CI 1.1-3.1), adeno cell type (RR 2.3 vs squamous cell, CI 1.4-4.0), as well as lymphangiosis carcinomatosa (RR 2.3, CI 1.2-4.4). Extent of operat ive resection, extent of lymphadenectomy, and sex did not influence surviva l. Conclusion: 5-year survival of our patients was in the range reported in literature. Most patients died of distant metastases. Our retrospective st udy probably underestimated the occurrence of second primary cancers of the lung. Limited resection in poor-risk patients showed equivalent results to lobectomy. The extent of lymph-node resections had no influence on surviva l of stage-1 patients, however, it must be remembered that positive results in lymph nodes shift patients to higher stages.