Original article
General thoracic
Surgical Resection Is Justified in Non-Small Cell Lung Cancer Patients with Node Negative T4 Satellite Lesions

Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.
https://doi.org/10.1016/j.athoracsur.2008.11.073Get rights and content

Background

The management of non-small cell lung cancer (NSCLC) depends on the stage, with a satellite nodule in the same lobe being classified as T4 stage IIIB even in node negative patients. Controversy exists as to the optimal management of these patients. Our objectives were to evaluate the outcomes in surgically resected patients with a T4 satellite lesion and to analyze the prognostic factors associated with outcome.

Methods

Patients who underwent resection for T4 (satellite nodule) N0-2M0 were identified. Patients with pure bronchoalveolar carcinoma were excluded. The primary endpoint studied was overall survival. Multiple covariates were analyzed for association with survival and recurrence.

Results

A total of 51 T4 N0-2 patients (men 22, women 29; median age 71 years [48 to 87]) underwent resection over a 7-year period. At a median follow-up of 26.4 months the estimated 5-year overall survival was 26% (95% confidence interval [CI] 14% to 50%; median survival 25.2 months). The estimated 5-year overall survival for T4 N0 patients was 40% (95% CI 23% to 68%; median survival 34.8 months). Size of the primary tumor, histology, and nodal status were significantly associated with overall survival; size and nodal status were significantly associated with disease-free survival.

Conclusions

Our results indicate that T4 (satellite nodule) N0 patients experienced excellent survival after surgical resection. These data support surgical resection in node negative patients. Size, histology, and nodal status were important prognostic variables associated with outcome. Consideration should be given to multimodality treatment in patients with adverse prognostic features. Further larger multiinstitutional studies are required to validate these findings.

Section snippets

Material and Methods

We retrospectively reviewed our experience with surgical resection for the treatment of T4 satellite lesions at the University of Pittsburgh from 1999 to July 2007. This study was approved by the Institutional Review Board of the University of Pittsburgh. Because this was a retrospective study, individual consent was waived.

Patients who underwent resection for T4 (by virtue of satellite nodule) N0-2M0 were identified from the University of Pittsburgh cancer registry. Satellite lesions were

Patient Characteristics

A total of 51 patients (men 22, women 29) with a median age of 71 years (range, 48 to 87) with T4 (satellite lesion) N0-2 lesions treated who met the study criteria were identified over a 7-year period. Of these patients, the T4 N0 group was composed of 34 patients and the T4 N1-2 group was composed of 17 patients (N1 = 10; N2 = 7). Patient characteristics are summarized in Table 1, Table 2.

Preoperative Staging

The satellite nodule was identified preoperatively in 24 of 51 (47%) patients. The details of

Comment

The management of NSCLC depends on the stage and this is clearly one of the most important determinants of survival. Treatment decisions are made based on stage, and IIIB lesions are typically treated by nonoperative therapy except under certain circumstances. Patients who are classified as stage IIIB on the basis of one or more satellite nodules, in particular node negative patients, may be excellent candidates for surgical resection. In this article, we report the outcomes of node negative T4

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