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Ann Thorac Surg 2004;77:1173-1178
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Histological determinants of survival in completely resected T1-2N1M0 nonsmall cell cancer of the lung

Omar A. Khan, MRCSa*, James J. Fitzgerald, MRCSa, Mark L. Field, MRCSa, Irshad Soomro, MRCPathb, F. David Beggs, FRCSa, W. Ellis Morgan, FRCSa, John P. Duffy, FRCSa

a Thoracic Unit, Nottingham City Hospital, Nottingham, United Kingdom
b Department of Histopathology, Nottingham City Hospital, Nottingham, United Kingdom

Accepted for publication August 21, 2003.

* Address reprint requests to Dr Khan, Thoracic Unit, Nottingham City Hospital, Hucknall Rd, Nottingham, UK NG5 1PB
e-mail: omarkhan{at}iname.com

BACKGROUND: The histologic determinants of survival after surgical resection of stage II nonsmall cell lung cancer are poorly understood. We analyzed the prognostic significance of a number of histologic features after complete resection of T1-2N1M0 nonsmall cell cancer of the lung.

METHODS: The case notes and histology of all patients who underwent a potentially curative surgical resection for T1-2N1M0 nonsmall cell carcinoma of the lung between 1991 and 1997 were reviewed retrospectively. The following histologic factors were recorded: histologic type of tumor; number of nodes with metastatic deposits together with their nodal station; the presence of vascular invasion, visceral pleural involvement, and cellular necrosis; and grade of tumor. The results from 98 patients were analyzed. Univariate and multivariate analyses were performed to identify prognostic factors.

RESULTS: Univariate analysis showed that only three factors had a statistically significant correlation with a poor prognosis: vascular invasion (p = 0.002), nonsquamous histology (p = 0.005), and visceral pleural involvement (p = 0.002). Multivariate analysis revealed that all three factors were significant independent adverse prognostic indicators.

CONCLUSIONS: Visceral pleural involvement, nonsquamous histology, and vascular invasion are all significant adverse prognostic factors after surgical resection of T1-2N1M0 nonsmall cell cancer of the lung. These findings conflict with previously published reports, and we advocate a prospective, large-scale study in order to clarify the prognostic significance of histologic characteristics in stage II disease.




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