Factors affecting long-term survival after en-bloc resection of lung cancer invading the chest wall

Objective: Several reports emphasize the importance of en-bloc resection as the optimal surgical treatment of lung cancer with chest wall invasion. We investigated possible factors which could affect long-term survival follow ing radical resection of these tumors. Methods: Between 1981 and 1998, 100 patients (90 male; ten female), with a median age of 60 years (36-84), unde rwent radical en-bloc resection of non-small cell lung cancer (NSCLC) with chest wall involvement. Patients with superior sulcus tumors invading the t horacic inlet were excluded from this series. There were 43 squamous and 57 non-squamous tumors. The median number of resected ribs was three (1-5). L ung resection included 73 lobectomies, two bilobectomies, 18 pneumonectomie s and seven segmentectomies. Chest wall resection also extended to the ster num in one patient, the transverse process in one, the costotransverse fora men and hemivertebrae in two. All patients had a complete resection. Sixty- three patients received postoperative radiotherapy and 12 received chemothe rapy. Histological data, including differentiation and depth of chest wall invasion, were carefully reviewed. The effect of various factors on surviva l were studied. Results: There were four in-hospital deaths. Lymph node inv olvement was negative on surgical specimens in 65 patients, and 28 patients had positive N1 nodes: the final histology revealed seven N2 diseases. Che st wall invasion was limited to the parietal pleura in 29 patients and incl uded intercostal muscles, bones and extrathoracic muscles in 67, 24 and sev en cases, respectively. The overall 2-year survival rate was 41%. The 5-yea r survival for patients with NO, N1 and N2 disease was 22, 9 and 0%, respec tively. A local recurrence occurred in 13 patients, with four having a new resection and 45 patients developing systemic metastases. The nodal status (N0-1 vs. N2; P = 0.026) and the number of resected ribs(<2 vs. >2; P = 0.0 3) were survival predictors in univariate analysis. By multivariate analysi s, the two independent factors affecting long-term survival were the histol ogical differentiation (well vs. poorly differentiated; P = 0.01) and the d epth of chest wall invasion (parietal pleura vs, others; P = 0,024). Conclu sions: Histological differentiation and depth of chest wall involvement wer e the main factors affecting long-term survival in this series. The role of induction chemotherapy for tumors with poor prognosis should be investigat ed. (C) 2000 Elsevier Science B.V. All rights reserved.