Effect of preoperative transbronchial biopsy on prognosis of non-small cell lung cancer

The aim of this study was to examine the hypothesis that post-surgical prognosis of patients with non-small cell lung cancer (NSCLC) proven by preoperative transbronchial biopsy (TBLB) was inferior to that of patients with NSCLC determined at time of surgery. Patients with NSCLC undergoing complete resection were divided into two groups. Group 1: pathologic diagnosis determined by TBLB consisting of 335 cases, and Group 2 where TBLB was unsuccessful and exploratory thoracotomy or thoracoscopy was followed by surgical resection, consisting of 186 cases. The post-surgical recurrence-free rate and survival rate were significantly higher in Group 2 than Group 1. Recurrence-free survival rate of stage IA patients in Group 2 (93 cases) was also significantly higher than that of stage IA Group 1 patients (70 cases) (p = 0.0018). Multivariate analyses demonstrated that positive TBLB yield was an independent negative determinant of prognosis in addition to pathologic staging and other clinicopathological factors. In conclusion, post-surgical prognosis of NSCLC patients was superior if preoperative TBLB was unsuccessful. This result suggested that advanced NSCLC had a tendency to be diagnosed with TBLB, and that the TBLB procedure might negatively impact the prognosis of patients with resectable NSCLC.