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Right arrow Lung - cancer

Ann Thorac Surg 2005;80:1021-1026
© 2005 The Society of Thoracic Surgeons

Original article: General thoracic

Proper Treatment Selection May Improve Survival in Patients With Clinical Early-Stage Nonsmall Cell Lung Cancer

Özcan Birim, MD a , A. Pieter Kappetein, MD, PhD a , * , Tom Goorden, MD a , Rob J. van Klaveren, MD, PhD b , Ad J.J.C. Bogers, MD, PhD a

a Department of Cardiothoracic Surgery, Erasmus MC Rotterdam, Rotterdam, the Netherlands
b Department of Pulmonology, Erasmus MC Rotterdam, Rotterdam, the Netherlands

Accepted for publication March 18, 2005.

* Address reprint requests to Dr Kappetein, Department of Cardiothoracic Surgery, Room BD 156, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands (Email: a.kappetein{at}erasmusmc.nl).

BACKGROUND: In patients with early-stage nonsmall cell lung cancer treatment selection is rarely assessed. Many surgical papers report only the outcome of patients who underwent surgery although selection may influence the outcome. In this report, treatment selection and the outcome of both surgically and nonsurgically treated patients is evaluated.

METHODS: Three hundred sixty patients (269 surgically treated and 91 nonsurgically treated) with clinical stage I and II were included. Risk factors were scaled according to the Charlson comorbidity index (CCI). Hospital morbidity and long-term survival were evaluated.

RESULTS: Mean age was 64 years for the surgical and 74 for the nonsurgical patients. Mean CCI score was 1.3 and 2.4, and 5-year survival was 47% and 3%, respectively. Male sex, pneumonectomy, and CCI score of 3 or more were predictive for major postoperative complications. For the nonsurgical patients receiving radiotherapy, the 2-year survival was 40%; for the patients receiving no radiotherapy, 2-year survival was 5%. Male sex, age, treatment, and clinical stage were prognostic for survival. Patients with a CCI score of 3 or more showed a better survival after surgery than after radiotherapy. Patients with a CCI score of 3 or more who were surgically treated had a higher prevalence of forced expiratory volume in 1 second of 70% or more compared with the patients receiving radiotherapy.

CONCLUSIONS: Patients with a CCI score of 3 or more have an increased risk of major postoperative complications. Nevertheless, patients with a CCI score of 3 or more show a better survival after surgery than after radiotherapy. For patients with significant comorbidity but with sufficient pulmonary reserve, surgery offers the best outcome. For patients with a high CCI score and insufficient pulmonary reserve or for those who refuse surgery curative, radiotherapy is a good alternative.




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