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Survival in synchronous vs. single lung cancer: upstaging better reflects prognosis
M T van Rens1, P Zanen, A Brutel de La Rivière
1Department of Pulmonary Diseases, and Thoracic Surgery, Sint Antonius Hospital, Nieuwegein. antolong@knmg.nl
Objective:
To define prognostic parameters for patients with synchronous non-small cell lung cancer (NSCLC).
Design:
Retrospective study of period from 1970 through 1997.
Patients:
Patients with a single (n = 2,764) and synchronous NSCLC (n = 85) who underwent pulmonary resection.
Methods:
All tumors were classified postsurgically, and the tumors of the patients with synchronous lung cancer were staged separately. The most advanced tumor was used for comparison. Actuarial survival time was estimated, and risk factors influencing survival were evaluated. Patients who died within 30 days of surgery were excluded.
Measurement And Results:
Five-year survival for single NSCLC was 41% and for synchronous lung cancer it was 19%. The relative risk of death for patients with synchronous lung cancer was 1.75, compared to that for patients with single lung cancer. The most advanced tumor in synchronous cancer was a significant predictor of survival (p<0.005). The survival of patients with synchronous lung cancer in which the most advanced tumors were stage I (n = 40) and stage II (n = 27) was not different from that of patients with stage II (n = 834) and stage IIIA (n = 405) single lung cancer, respectively.
Conclusion:
The poorer survival of patients with synchronous NSCLC is confirmed and quantified. The stage of the most advanced tumor was the best predictor of prognosis. The prognosis of patients with synchronous NSCLC resembles the prognosis of patients with a single lung cancer of a higher stage. Upstaging in synchronous lung cancer is recommended on the basis of these observations.