Original article
General thoracic
Local Extension at the Hilum Region Is Associated With Worse Long-Term Survival in Stage I Non-Small Cell Lung Cancers

https://doi.org/10.1016/j.athoracsur.2011.09.079Get rights and content

Background

The prognostic significance of hilar structures invasion, which remains undefined for non-small cell lung cancer (NSCLC), may have potential application for cancer staging. Tumor extension along the bronchus and pulmonary vessels was examined for survival significance.

Methods

In all, 213 pathologically proved central-type stage I NSCLC cases were enrolled. Four study groups were assigned based on the extent of resections: standard lobectomy (group L, n = 32), bronchoplastic procedures (group B, n = 94), standard lobectomy combined with pulmonary angioplasty (group A, n = 48), and bronchial sleeve resection combined with pulmonary artery angioplasty (group BA, n = 39). Univariate and multivariate analysis were performed by the Kaplan-Meier method and the Cox regression model.

Results

There were 2 postoperative deaths (pulmonary embolism and serious pulmonary infection). Complications were noted in 39 patients (18.3%). Among these patients, the overall 5-year survival rate was 60.2% ± 0.05%, with a median survival time of 75.0 ± 7.5 months. The 5-year survival rates of subgroups were 79.5%, 59.7%, 59.0%, and 47.9%, respectively for groups L, B, A, and BA. Univariate analysis indicated tumor size, bronchial invasion, arterial involvement, and type of operation as closely associated with long-term survival. Multivariate analysis indicated that type of operation and tumor size were the most prominent prognostic factors of 5-year survival.

Conclusions

Proximal tumor extension into bronchus, invasions into extrapericardial pulmonary vessels, and tumor size were the most important risk factors for 5-year survival with central-type stage I NSCLC. Tumor extension in the hilum was highly related to prognosis and might provide pertinent information to accurately define a tumor (“T”) subclass.

Section snippets

Patients and Methods

Approval for the study was obtained from the Hospital Ethics Committee.

General Information

In all, 213 cases with stage T1-2N0M0, central-type NSCLC were finally enrolled in the present study. All patients underwent lobectomies, with or without bronchoplastic or angioplastic operations, or both. The mean age was 60.4 ± 10.6 years (range, 12 to 80 years); 183 patients (85.9%) were male and 30 (14.1%) were female. There were 133 (62.4%) squamous cell carcinomas, 39 (18.3%) adenocarcinomas, and 41 (19.3%) other histologic types. Tumor size ranged from 0.5 to 5 cm (mean 3.42 ± 1.19 cm).

Comment

Non-small cell lung cancers of the hilar region are commonly defined as stage I if there is no lymph node metastasis and the tumor diameter is less than 5 cm, regardless of possibly varied resection extent and surgical techniques. For these central-type lung cancers, however, conditions T1/T2 possibly comprise a wide range of disease composites, considering the various kinds of involved hilar structures. Practically, it could also be quite confusing that tumors requiring complicated and

Cited by (0)

Drs Chang Chen and Fang Bao are both first authors.

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