Significance of lymphangiosis carcinomatosa at the bronchial resection margin in patients with non-small cell lung cancer

Background. Treatment options for patients with microscopic residual diseas e at the bronchial margin (R1-resection) after resection for non-small cell lung cancer include observation, radiotherapy, reoperation, or even system ic therapy. The present study was performed to identify a parameter that wo uld estimate the prognosis of these patients more precisely to permit a wel l-founded treatment recommendation for the individual patient. Methods. A total of 1,162 patients with resected nonsmall cell lung cancer were analyzed in this retrospective study. Fifty-four patients (4.6%) had R 1-resections at the bronchial margin. Type of residual disease (mucosal, ex tramucosal, or involvement of the entire bronchial wall) and occurrence of tumor cells in the lymphatic vessels (lymphangiosis carcinomatosa) were rec orded as distinct parameters and analyzed by univariate and multivariate an alyses (Log rank test; Cox regression model). Results. Lymphangiosis carcinomatosa at the bronchial margin was detected i n 22 patients (40.7%) and was associated with a significantly shortened sur vival (median survival with lymphangiosis carcinomatosa, 13.3 months; witho ut lymphangiosis carcinomatosa, 20.1 months; P = 0.026). Early stage patien ts (stage I-II) without lymphangiosis carcinomatosa showed a median surviva l of 49 months. Multivariate analysis revealed that lymphangiosis carcinoma tosa at the resection margin is an independent prognostic parameter (p = 0. 038). Even after postoperative radiotherapy the prognosis was still poor if a lymphangiosis carcinomatosa was detected (median survival, 17.1 months). All other parameters (T-stage, N-stage, tumor histology, type of bronchial wall involvement) were not of prognostic significance in R1-resected patie nts. Conclusions. Lymphangiosis carcinomatosa at the bronchial resection margin predicts a poor prognosis in patients with non-small cell lung cancer. It i s more than questionable whether these patients would benefit from local tr eatment options like radiotherapy. (C) 2001 by The Society of Thoracic Surg eons.