Marginal pulmonary function should not preclude lobectomy in selected patients with non-small cell lung cancer

Current clinical trials are investigating the role of stereotactic body radiation therapy (SBRT) versus sublobar resection for patients with non-small cell lung carcinoma (NSCLC) and marginal pulmonary function tests (M-PFTs). We compared the outcomes of patients undergoing lobectomy with M-PFTs characterized by 2 accepted M-PFT criteria.

A total of 1,259 consecutive patients underwent lobectomy for NSCLC between 1999 and 2011. Patients were stratified into 2 classifications of M-PFT: American College of Surgeons Oncology Group (ACOSOG) Z4099/Radiation Therapy Oncology Group (RTOG) 1021 trial or American College of Chest Physicians (ACCP) criteria. There were 206 patients classified as having M-PFT according to ACOSOG Z4099/RTOG 1021 criteria and 131 patients classified as having M-PFT by ACCP criteria. The primary endpoints of the study were post-operative complications and survival.

Median follow-up was 3.8 years. Cox-proportional survival analysis found that pathologic stage (P < .001), age (P < .001), and higher Zubrod functional status (P < .001) were independent predictors of mortality. Using multivariable analysis for major morbidity, M-PFT status was not associated with the development of a major complication following lobectomy (P = .68). M-PFT classification was not an independent predictor of mortality when controlling for other variables (ACOSOG Z4099/RTOG 1021 [P = .34]; ACCP criteria [P = .83]). A composite major morbidity analysis for major morbidity following lobectomy showed no association between clinicopathologic variables or M-PFTs and the occurrence of a major postoperative morbidity.

In carefully selected patients with M-PFTs, lobectomy for NSCLC can be performed with acceptable morbidity and mortality. These results need to be considered when deciding if a patient should undergo lobectomy or other therapies for resectable NSCLC.