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Ann Thorac Surg 2005;80:2032-2040
© 2005 The Society of Thoracic Surgeons
a Department of Thoracic Surgery, Hôpital Sainte-Marguerite, Marseille, France
b Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
c Thoracic Surgery Unit, Centre Médico-Chirurgicale du Cèdre, Boisguillaume, France
d Unité Propre de Recherche et d'Enseignement Supérieur, Equipe d'Acceuil 2201, Institut Fédératif de Recherche, Jean Roche, Marseille, France
Accepted for publication March 21, 2005.
* Address correspondence to Dr Doddoli, Sainte-Marguerite Hospital, 270, Blvd de Sainte-Marguerite, 13274 Marseille Cedex 09, France (Email: christophe.doddoli{at}mail.ap-hm.fr).
BACKGROUND: Factors influencing survival of patients with a nonsmall-cell lung cancer (NSCLC) invading the parietal pleura or the chest wall are still controversial. The aim of this study was to assess prognostic factors in completely resected pT3 chest wall NSCLC patients.
METHODS: We retrospectively reviewed a three-center experience between 1984 and 2002 with 309 patients.
RESULTS: There were 269 male and 40 female patients. Pulmonary resections consisted of 13 wedge resections or segmentectomies, 211 lobectomies, 6 bilobectomies, and 79 pneumonectomies. One hundred patients underwent extrapleural mobilization, and 209, en-bloc resection. Tumors were staged as stages IIB (n = 212) and IIIA (n = 97). Overall 5-year survival rates were 40% and 12% for stage IIB and IIIA, respectively (p < 104). Multivariate analysis shows male sex and bigger tumor size as independent indicators of poor prognosis in stage IIB patients. In stage IIB patients with a chest wall invasion limited to the parietal pleura, en-bloc resections provided higher 5-year survival rates when compared with extrapleural resections (60.3% versus 39.1%; p = 0.03). In stage IIIA patients, multivariate analysis disclosed two independent prognostic factors: the number of resected ribs and adjuvant parietal and mediastinal radiotherapy.
CONCLUSIONS: The presence of lymph node metastases has a disastrous impact on survival in this subset of patients. En-bloc resection is strongly suggested to be the standard of surgical care, and adjuvant radiotherapy does not seem to be necessary in N0 patients when a complete R0 resection has been achieved. For huge tumors (larger than 6 cm), this report suggests that the role of perioperative chemotherapy needs further evaluation.
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W. J. Scott Invited commentary Ann. Thorac. Surg., December 1, 2005; 80(6): 2040 - 2040. [Full Text] [PDF]
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