[Prognostic factors on surgical treatment for lung cancer]

The factors for determining prognosis after lung cancer surgery are curative operation, pathological stage, pathological classification, adjuvant and neoadjuvant therapies, expression of cancer related genes, and concomitant diseases. In particular, pathological stage (especially N stage) is the most influential factor for tumor recurrence, metastasis and survival. The revision of TNM classification by The Union Internationale Contre le Cancer (UICC) in 1997 was well correlated with prognosis. The 5 year survival rates of stage Ia, Ib, IIa, IIb, and IIIa were 67, 57, 55, 39, and 23%, respectively. Neoadjuvant chemotherapy for clinical N 2 disease is expected to improve surgical curativity and survival. Tumor markers including carcinoembryonic antigen (CEA), CYFRA 21-1, and expression of cancer related genes, such as Ki 67, K-ras, bcl-2 and telomerase, are reported to reflect survival after surgery. Smoking and concomitant pulmonary diseases, such as chronic obstructive pulmonary diseases (COPD) and interstitial lung disease affect postoperative patient quality of life (QOL) and survival. We should examine these factors precisely, predict each patient's prognosis and establish an appropriate treatment strategy for each patient.