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Published on: September 27, 2024
Prognostic factors and survival in patients undergoing surgery for T4 nonsmall cell lung carcinoma
Background:
Surgical treatment of T4 non-small cell lung carcinoma (NSCLC) is controversial.
Methods:
Between 1998 and 2011, 70 patients undergoing pulmonary resection for T4 NSCLC were evaluated. The patients were divided into four groups: the large vessels group (n = 28), the carinal group (n = 20), the separate tumor nodules group (n = 13) and the mediastinal fat group (n = 9).
Results:
Overall mortality and morbidity were 12.9% (n = 9) and 35.7% (n = 25), respectively and there was no significant differences between the four groups (p = 0.961, p = 0.750). Complete resection was possible in 47 patients (67.1%). The pathological nodal status was as follows: N0/1 in 58 patients and N2 in 12 patients. Five-year survival rate was 28.9% for all patients and 49.6%, 18.5%, 0% and 20.5% in the carinal, large vessels, mediastinal fat and separate tumor nodule groups, respectively. The carinal group was significantly different from the other groups in terms of survival (p = 0.05). By multivariate analysis, only two factors significantly and independently influenced survival: nodal status (N0/N1 versus N2; p = 0.01) and complete resection (R0 versus R1; p = 0.06).
Conclusion:
Resection is not a suitable approach for T4 NSCLC patients with N2 disease or incomplete resection. Resectable T4 NSCLC patients with carinal or tracheal involvement have better survival than do other T4 sub-groups.
