Original article: general thoracic
Characteristics and prognosis of resected T3 non-small cell lung cancer

https://doi.org/10.1016/S0003-4975(01)03264-7Get rights and content

Abstract

Background. T3 tumors can be divided into several subgroups depending on the type of anatomical structure invaded: chest wall, mediastinal pleura, or main bronchus. The aim of this study was to analyze the characteristics and prognosis of each subgroup of T3 tumors.

Methods. The results of surgical treatment were retrospectively analyzed for 261 patients with T3 non-small cell lung cancer invading either the mediastinal pleura or parietal pericardium by direct extension (mediastinal pT3, n = 68), or main bronchus (bronchial pT3, n = 68), or chest wall (chest wall pT3, n = 125) that were operated on between 1984 and 1996. Complete resection including radical mediastinal lymph node dissection was intended in all patients. One patient had segmentectomy, 91 had lobectomy (34.9%), and 169 had pneumonectomy (64.8%). One hundred and fifty-eight patients received adjuvant radiation therapy and 7 patients received both adjuvant chemotherapy and radiation therapy. Actuarial survival curves were drawn using the Kaplan-Meier method and risk factors for late death were identified.

Results. In-hospital mortality was 6.1%. Follow-up was 98% complete. Global 5-year survival was 28%, with survival being not significantly different among the three subgroups: 34.9%, 30.6%, and 22.5% (p = 0.19) in the bronchial pT3, mediastinal pT3, and chest wall pT3 subgroups, respectively. Resection margins were microscopically invaded in 33 patients (12.6%). Seventy-four patients had N1 involvement (28.4%) and 78 patients had N2 involvement (29.8%). N0 involvement was more prevalent in the chest wall pT3 subgroup, whereas N1 involvement was more prevalent in the bronchial pT3 subgroup and N2 involvement was more prevalent among patients with mediastinal invasion. Pathologic factors influencing the 5-year survival were tumor size (p = 0.03) and N involvement (p = 0.003). Histology, type of surgical resection (lobectomy versus pneumonectomy), and use of adjuvant therapy did not influence survival significantly.

Conclusions. Five-year survival was not significantly different among the three subgroups of pT3 non-small cell lung cancer, although bronchial pT3 tumors tended to have a better prognosis and chest wall pT3 tumors tended to have a worse prognosis. The pathologic characteristics of each pT3 subgroup seems different. Further research is warranted to explore the pathologic and biological factors influencing prognosis for each pT3 subgroup.

Section snippets

Patients and methods

From January 1984 to December 1996, 1,590 patients underwent pulmonary resection for NSCLC at Laennec Hospital and Boisguillaume Surgical Center. In all cases, the surgical procedure was a complete potentially curative resection with an extensive mediastinal lymph node dissection similar to that described by Martini and Flehinger [2]. All surgical specimens were studied by the same pathologist, who has reviewed all pathology notes for this study. Surgical pathologic distribution of T disease

Characteristics

Patient samples did not differ significantly among the three pT3 subgroups. Sex ratios were grossly the same and mean ages were 59.6 years, 60.2 years, and 61.9 years in the chest wall, bronchial, and mediastinal pT3 subgroups, respectively. Characteristics of the tumors are reported in Table 1. Lobectomies were more frequent among cases with chest wall pT3. Tumor size ranged from 0.2 cm to 19 cm in diameter (mean = 5.86 cm). The smallest tumors were found in the bronchial pT3 subgroup (p <

Comment

An extensive review of the English-language literature reveals that most of the articles studying pT3 NSCLC concern chest wall involvement only 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15. Some reports concern lung cancer invading the mediastinum but include T4 as well 16, 17, 18, 19. Only a few reports have focused on other subgroups than chest wall pT3 20, 21, 22. In addition, the pathologic characteristics of each subgroups are difficult to assess from the literature. This study was performed to

References (28)

Cited by (47)

  • Patterns of Failure After Surgery for Non–Small-cell Lung Cancer Invading the Chest Wall

    2017, Clinical Lung Cancer
    Citation Excerpt :

    The 5-year survival rate has been reported to range from 25% to 55%, with worse outcomes in patients with incomplete surgical resection and N2 nodal disease.8-13 The crude rates of local disease recurrence, generally defined as recurrence within the primary site or chest wall, have also varied widely in published reports from 1% to 17%.3,11,14-16 The role of adjuvant radiation therapy (RT) for patients with resected NSCLC with chest wall invasion remains controversial and largely undefined.

  • Prognostic Differences in Subgroups of Patients With Surgically Resected T3 Non-Small Cell Lung Cancer

    2016, Annals of Thoracic Surgery
    Citation Excerpt :

    The reason for this observation is not clear, but it likely relates to the early detection of tumors centrally located in the main bronchus, which resulted in respiratory symptoms. N1 disease appeared common in the T3-cent group, with reported N1 rates up to 51.5% [4, 5]. Riquet and colleagues [5] assumed that the proximity between extralobar lymph nodes and the main bronchus would affect N1 involvement.

View all citing articles on Scopus
View full text