Surgeons' assessment of symptoms suggesting extrathoracic metastases in patients with lung cancer

Background. In patients with apparently operable nonsmall cell lung cancer (NSCLC), clinicians often omit investigation for M disease in asymptomatic patients. Previous investigations have not specified in detail what is mean t by "symptomatic," and this could differ between surgeons. We have investi gated the extent to which surgeons' criteria differ for presence of symptom s. Methods. Participating surgeons from seven centers, enrolled patients they judged "asymptomatic" in a randomized trial of investigational strategies f or NSCLC. Patients completed a structured questionnaire describing symptoms of the central nervous system (CNS). In 685 patients, we documented CNS sy mptom recurrence after resectional surgery over 1 year of follow-up. Results. Two centers enrolled only patients without even the mildest sympto ms. Three centers took an intermediate approach, occasionally classifying p atients with mild symptoms as "asymptomatic" and thus enrolling them in the trial. Two centers classified an appreciable number of patients with minim al symptoms, and occasionally with more than minimal symptoms, as "asymptom atic." Patients with even mild CNS symptoms were more likely to subsequentl y present with CNS metastases. Conclusions. Thoracic surgeons differ in their ideas of what may constitute the symptoms of M disease. Patients with structured questionnaire results that suggest symptoms of CNS disease are more likely to have CNS symptom re currence after resectional surgery. (C) 1999 by The Society of Thoracic Sur geons.