Predictors of long time survival after lung cancer surgery: a retrospective cohort study

Kjetil Roth, Tom Ivar Lund Nilsen, Elisabeth Hatlen, Karina Søvik Sørensen, Torstein Hole, Rune Haaverstad, Kjetil Roth, Tom Ivar Lund Nilsen, Elisabeth Hatlen, Karina Søvik Sørensen, Torstein Hole, Rune Haaverstad

Abstract

Background: There have been few reports regarding long time survival after lung cancer surgery. The influence of age and pulmonary function on long time survival is still not fully discovered. Some reports suggest that hospitals with a high surgical volume have better results. The aim of this study was to evaluate lung cancer surgery performed in a county hospital in terms of 30 days mortality, complications and predictors of long time survival.

Methods: All patients operated with non-small cell lung cancer in the period 1993-2006 were reviewed, and 148 patients were included in the study. 30 days mortality and complications were analyzed by univariate analysis. Kaplan Meier plots were performed to display some of the univariate variables. Cox regression analysis was performed to find Hazard Ratios (HR) that predicted long time survival in univariate and multivariate analysis.

Results: The overall 30 days mortality rate was 2.7%, whereas 36.3% had one or more complications after surgery. The median survival time was 3.4 years. In multivariate Cox regression analysis advanced preoperative stage predicted reduced long time survival with HR (95%CI) 1.63 (0.92, 2.89) and 4.16 (1.92, 9.05) for patients in stage IB and II-IV respectively, when compared to patients in stage IA. Age >or= 70 years and FEV1<80% predicted reduced long time survival with HR (95%CI) 2.23 (1.41, 3.54) and 1.93 (1.14, 3.28) respectively, compared to age<70 years and FEV1 >or= 80%.

Conclusion: Thirty days mortality and complication rate showed that lung cancer surgery can be performed safely in a county hospital with experienced thoracic surgeons. Early preoperative stage, age below 70 years and normal pulmonary function predicted long time survival.

Figures

Figure 1
Figure 1
Postoperative survival curve (Kaplan-Meier plot) for all patients.
Figure 2
Figure 2
Kaplan-Meier plot for overall survival stratified by age.
Figure 3
Figure 3
Kaplan-Meier plot for overall survival stratified by preoperative stage.
Figure 4
Figure 4
Kaplan-Meier plot for overall survival stratified by preoperative pulmonary function.

References

    1. Janssen-Heijnen MLG, Coebergh JWW. The changing epidemiology of lung cancer in Europe. Lung Cancer. 2003;41:245–258. doi: 10.1016/S0169-5002(03)00230-7.
    1. Beamis JF, Stein A, Andrews JL. Changing Epidemiology of Lung-Cancer – Increasing Incidence in Women. Chest. 1975;68:401–402.
    1. Belani CP, Marts S, Schiller J, Socinski MA. Women and lung cancer: Epidemiology, tumor biology, and emerging trends in clinical research. Lung Cancer. 2007;55:15–23. doi: 10.1016/j.lungcan.2006.09.008.
    1. Bach PB, Cramer LD, Schrag D, Downey RJ, Gelfand SE, Begg CB. The influence of hospital volume on survival after resection for lung cancer. New England Journal of Medicine. 2001;345:181–188. doi: 10.1056/NEJM200107193450306.
    1. Batevik R, Grong K, Segadal L, Stangeland L. The female gender has a positive effect on survival independent of background life expectancy following surgical resection of primary non-small cell lung cancer: a study of absolute and relative survival over 15 years. Lung Cancer. 2005;47:173–181. doi: 10.1016/j.lungcan.2004.08.014.
    1. Bernard A, Ferrand L, Hagry O, Benoit L, Cheynel N, Favre JP. Identification of prognostic factors determining risk groups for lung resection. Annals of Thoracic Surgery. 2000;70:1161–1167. doi: 10.1016/S0003-4975(00)01853-1.
    1. Deslauriers J, Ginsberg RJ, Piantadosi S, Fournier B. Prospective Assessment of 30-Day Operative Morbidity for Surgical Resections in Lung-Cancer. Chest. 1994;106:S329–S330. doi: 10.1378/chest.106.6.329S.
    1. Hung JJ, Wang CY, Huang MH, Huang BS, Hsu WH, Wu YC. Prognostic factors in resected stage I non-small cell lung cancer with a diameter of 3 cm or less: Visceral pleural invasion did not influence overall and disease-free survival. Journal of Thoracic and Cardiovascular Surgery. 2007;134:638–643. doi: 10.1016/j.jtcvs.2007.04.059.
    1. Myrdal G, Gustafsson G, Lambe M, Horte LG, Stahle E. Outcome after lung cancer surgery. Factors predicting early mortality and major morbidity. European Journal of Cardio-Thoracic Surgery. 2001;20:694–699. doi: 10.1016/S1010-7940(01)00875-2.
    1. Visbal AL, Williams BA, Nichols FC, Marks RS, Jett JR, Aubry MC, et al. Gender differences in non-small-cell lung cancer survival: An analysis of 4,618 patients diagnosed between 1997 and 2002. Annals of Thoracic Surgery. 2004;78:209–215. doi: 10.1016/j.athoracsur.2003.11.021.
    1. Bernard A, Deschamps C, Allen MS, Miller DL, Trastek VF, Jenkins GD, et al. Pneumonectomy for malignant disease: Factors affecting early morbidity and mortality. Journal of Thoracic and Cardiovascular Surgery. 2001;121:1076–1081. doi: 10.1067/mtc.2001.114350.
    1. Harpole DH, Decamp MM, Daley J, Hur K, Oprian CA, Henderson WG, et al. Prognostic models of thirty-day mortality and morbidity after major pulmonary resection. Journal of Thoracic and Cardiovascular Surgery. 1999;117:969–979. doi: 10.1016/S0022-5223(99)70378-8.
    1. Ploeg AJ, Kappetein AP, van Tongeren RB, Pahlplatz PV, Kastelein GW, Breslau PJ. Factors associated with perioperative complications and long-term results after pulmonary resection for primary carcinoma of the lung. European Journal of Cardio-Thoracic Surgery. 2003;23:26–29. doi: 10.1016/S1010-7940(02)00655-3.
    1. Dahle G, Broyn T, Stavem K. Surgery for non-small cell lung cancer. Tidsskr Nor Laegeforen. 2007;123:1525–1526.
    1. Volpino P, Cangemi R, Fiori E, Cangemi B, De Cesare A, Corsi N, et al. Risk of mortality from cardiovascular and respiratory causes in patients with chronic obstructive pulmonary disease submitted to follow-up after lung resection for non-small cell lung cancer. Journal of Cardiovascular Surgery. 2007;48:375–383.
    1. Gail MH, Eagan RT, Feld R, Ginsberg R, Goodell B, Hill L, et al. Prognostic Factors in Patients with Resected Stage-I Non-Small Cell Lung-Cancer – A Report from the Lung-Cancer Study-Group. Cancer. 1984;54:1802–1813. doi: 10.1002/1097-0142(19841101)54:9<1802::AID-CNCR2820540908>;2-4.
    1. Kearney DJ, Lee TH, Reilly JJ, Decamp MM, Sugarbaker DJ. Assessment of Operative Risk in Patients Undergoing Lung Resection – Importance of Predicted Pulmonary-Function. Chest. 1994;105:753–759. doi: 10.1378/chest.105.3.753.
    1. Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B, et al. Pulmonary complications following lung resection – A comprehensive analysis of incidence and possible risk factors. Chest. 2000;118:1263–1270. doi: 10.1378/chest.118.5.1263.
    1. Licker M, de Perrot M, Hohn L, Tschopp JM, Robert J, Frey JG, et al. Perioperative mortality and major cardio-pulmonary complications after lung surgery for non-small cell carcinoma. European Journal of Cardio-Thoracic Surgery. 1999;15:314–319. doi: 10.1016/S1010-7940(99)00006-8.
    1. Bousamra M, Presberg KW, Chammas JH, Tweddell JS, Winton BL, Bielefeld MR, et al. Early and late morbidity in patients undergoing pulmonary resection with low diffusion capacity. Annals of Thoracic Surgery. 1996;62:968–974. doi: 10.1016/0003-4975(96)00476-6.
    1. Kroenke K, Lawrence VA, Theroux JF, Tuley MR. Operative Risk in Patients with Severe Obstructive Pulmonary-Disease. Archives of Internal Medicine. 1992;152:967–971. doi: 10.1001/archinte.152.5.967.
    1. Shah R, Sabanathan S, Richardson J, Mearns AJ, Goulden C. Results of surgical treatment of stage I and II lung cancer. Journal of Cardiovascular Surgery. 1996;37:169–172.

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