Risk analysis and long-term survival in patients undergoing resection of T4 lung cancer

Objective: The aim of this study is to identify the risk group of patients with T4 lung cancer who could more likely benefit from surgical resection. Methods: Between January 1, 1990, and December 31, 1998, 77 patients underw ent pulmonary resection for T4 lung cancer: lobectomy (n = 20), bilobectomy (n = 4) and pneumonectomy (n = 53). The T4 sites of mediastinal involvemen t were: Intrapericardiac portions of the pulmonary artery (n = 30), left at rium (n = 19), aorta (n = 8), superior vena cava (n = 8), carina (n = 7), t he esophagus. (n = 8) and the vertebral body (n = 6). Ten patients had mult iple neoplastic nodules in the same lobe of the lung. Results: Overall surv ival rates at 1, 2 and 3 years were 46, 31 and 21%. respectively. Factors a dversely affecting survival with univariate analysis included the localizat ion of tumours in the lower lobe (P = 0.04) and both the involvement of sup erior and inferior mediastinal lymph nodes (P = 0.03). Multivariate analysi s included two factors adversely affecting survival: the location of the pr imary tumour and the nodal stations involved. Regression tree analysis clas sified the patients into low-risk group (primary tumour in upper lobe or in main stem bronchus and pN0 or pN1 or superior or inferior mediastinal node s involved), intermediate-risk group (primary tumour in upper lobe or in ma in stem bronchus and both superior and inferior mediastinal nodes involved, primary tumour in inferior lobe and pN0 or pN1 or inferior mediastinal nod es involved) and high-risk group (primary tumour in inferior lobe and both superior and inferior nodes involved). The 3-year survival rates were 36% f or the low-risk group, 4% for the intermediate-risk group and 0% for the hi gh-risk group (P = 0.006). Conclusions: In patients with T4 lung cancer, th e surgery can justify itself for tumours in the upper lobe or in the main s tem bronchus and with pN0 or pN1. (C) 2001 Elsevier Science B.V. All rights reserved.