[Surgical treatment of lung cancer: comparative assessment of the staging systems of 1986 and 1997. Results in 500 consecutive patients].
OBJECTIVE
To evaluate the influence of different variables on survival in relation to the staging guidelines of 1986 and 1997.


METHODS
Five hundred patients (473 men and 27 women) with non-small cell lung cancer were treated surgically from 1980 to 1997. Resections performed: 184 lobectomies, 16 bi-lobectomies, 244 pneumonectomies, 2 bronchoplastic lobectomies, and 54 segmentectomies.


RESULTS
338 epidermoid, 86 adenocarcinoma, 40 giant cell, 36 mixed tumor. Differentiation: 216 N1, 91 N2, 193 N3. Stages according to 1986 guidelines were I: 246 (49.2%) (T1: 32, T2: 214); II: 27 (5.4%); IIIa: 197 (39.4%) (N0: 84; N1: 2; N2: 111); IIIb: 23 (4.6%) (N0: 12; N2: 11); and IV: 7 (1.4%) (N0: 4; N2: 3). Stages according to the 1997 guidelines were used for comparison of survival between patients with Ia and Ib tumors and with IIb and IIIa tumors.


RESULTS
With follow-up periods ranging from 2 to 17 years, 141 patients (28%) were alive, 26 (5%) were lost to follow-up and 333 had died. Two patients (0.4%) died during surgery and 36 (7.2%) died during the postoperative period. Among the remaining 462 patients, 295 deaths were related to the following causes: metastasis in 130 cases (44%), recurrence in 81 cases (27%), functional causes in 17 (6%), independent causes in 54 (18%) and unknown causes in 13 (4%). Overall survival rates at 5 and 10 years were 36 and 26%, respectively; survival rates by histological type: epidermoid 36 and 26%, adenocarcinoma 35 and 26%; stage I, 51 and 41% (Ia, 81 and 75%; Ib, 44 and 33%); IIIa 24 and 15% (IIb of 1997: 27 and 17%; IIIa of 1997: 20 and 13%). Survival by N factor: N0, 44 and 34%; N2, 17 and 8% (1986) and 17 and 11% (1997).


CONCLUSIONS
Survival agrees with other studies. The 1997 staging guidelines are useful for differentiating survival between stages Ia and Ib and between IIb and IIIa. N and T factors, histology and stage influence the appearance of metastasis; T factor influences recurrence.
Servicio de Cirugía Torácica, Hospital Universitario, Valladolid.
M
M
García-Yuste
J M
JM
Matilla
J L
JL
Duque
F
F
Heras
L J
LJ
Cerezal
G
G
Ramos
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors