Non-small cell lung cancer: Prognostic factors in patients treated with surgery and postoperative radiation therapy

PURPOSE: To determine survival outcomes, to identify adverse prognostic fac tors for relapse, and to compare American Joint Commission on Cancer (AJCC) staging systems in patients:with non-small cell lung cancer (NSCLC) treate d with surgery and postoperative radiation therapy. MATERIALS AND METHODS: Between 1980 and 1995, 211 patients with NSCLC under went surgery and postoperative radiation therapy. Surgery consisted of wedg e resection (12.5%), lobectomy (67.8%), or pneumonectomy (19.7%). Pathologi c stages (1992 AJCC) included I (n = 22), II (n = 70), IIIA (n = 104), and IIIB (n = 12). Indications for radiation therapy included compromised margi ns (n = 81) and/or positive mediastinal nodes (n = 55). Prognostic factors were identified by using univariate and multivariate models. RESULTS: Overall 3-year survival for patients with stage I, II, and IIIA ca ncer was 58.9%, 44.1%, and 43.2%, respectively. Older age (P = .008), male sex (P = .021), large primary tumor (P = .004), and multiple positive media stinal nodes (P = .046) were associated with worse rates of survival. Actua rial risk of local-regional relapse (36 patients)was 21.4% at 3 years. In a multivariate model, use of wedge resection (P = .001), positive margins (P = .010), and larger pathologic tumor (P = .059) were risk factors for loca l-regional recurrence. Actuarial rate of distant failure was 55.2% at 3 yea rs. CONCLUSION: Local-regional control can be achieved with surgery and radiati on therapy in approximately 80% of patients; however, the rate of distant m etastasis remains unacceptably high. Other variables, such as multiple posi tive nodes, may serve to identify patients at higher risk for relapse and p oorer survival. Methods for improving treatment outcomes in these patients should be pursued.