Factors determining outcome after surgical resection of T3 and T4 lung cancers of the superior sulcus

Background: The treatment of superior sulcus lung cancers is evolving and p reoperative chemotherapy is increasingly used. To establish a historical be nchmark against which new therapies can be assessed, we reviewed our 24-yea r experience with patients undergoing thoracotomy for lung cancers of the s uperior sulcus. Methods: Data were acquired through retrospective chart review. Overall sur vival was calculated by the method of Kaplan and Meier, and prognostic fact ors were examined by log rank and Cox proportional hazards modeling. Results: From 1974 to 1998, 225 patients underwent thoracotomy. The patient s included 144 men (64%) and 81 women with a median age of 55 years. The ma jority of patients (55%) received preoperative radiation, but 35% did not h ave any preoperative treatment. Tumor stages were IIB (T3 NO) in 52%, IIIA in 15%, and IIIB in 27% of patients. Complete resection was achieved in 64% of T3 NO tumors, 54% of T3 N2 tumors, and 39% of T4 N0 tumors. Operative m ortality was 4%. Median survival was 33 months for stage IIB and 12 months for both stages IIIA and IIIB. Actuarial 5-year survivals were 46% for stag e IIB, 0% for stage IIIA, and 13% for stage IIIB. By univariate and multiva riable analyses, T and N status and complete resection had a significant im pact on survival. Locoregional disease was the most common form of relapse. Conclusions: Our results provide a benchmark against which new treatment re gimens can be evaluated. Control of locoregional disease remains the major challenge in treating lung cancers of the superior sulcus. The potential be nefit of preoperative chemotherapy or chemoradiotherapy must be assessed by whether it leads to higher rates of complete resection and a lower risk of local relapse.