Adenocarcinoma of the lung--clinical features and survival

Four thousand patients were registered by the Edinburgh Lung Cancer Group in 1981-1987; 9.5% had adenocarcinoma. Of these, 102 patients with pathological confirmation of the diagnosis, presenting to one hospital group in Edinburgh, were reviewed. Two cases were excluded after case note review. Of the remaining 100, 64 were male and 36 were female, with a mean age of 73 years. The majority (89%) were smokers or ex-smokers, and 52% had a poor performance status (Karnofsky Index 10-70). Significantly, more adenocarcinoma patients underwent surgery compared to other cell types (39 vs. 19%, P < 0.01), and less were treated with radiotherapy (19 vs. 31%). The 5-yr survival rate for the adenocarcinoma patients was 19 vs. 7% in the remainder of patients. Of 39 patients referred for surgery, 37 had lung resections and their 5-yr survival rate was 42%. Post-operative staging showed 48% in Stage I, 27% in Stage II and 24% in Stage III. The majority of the long-term survivors had Stage I disease (64%). Forty-two percent of the patients received palliative therapy alone (all died within 10 months). Ten percent of patients receiving radiotherapy survived for 5 yr. Review of these cases suggested two patterns of presentations: (1) patients with poor performance status, extensive disease and often pleural involvement (16%); and (2) patients with more localized disease (39%), many of whom were suitable for surgical resection with surprisingly good prognosis.