title: Stage I non-small cell lung carcinoma: really an early stage?
abstract: OBJECTIVE
  We review our results on surgical treatment of patients with stage I non-small cell lung carcinoma and we attempted to clarify the prognostic significance of some surgical--pathologic variables.
  
  
  METHODS
  From 1993 to 1999, 667 patients received curative lung resection and complete hilar and mediastinal lymphadenectomy for non-small cell lung cancer. Of these, there were 436 Stage I disease (65%), of whom 144 T1N0 and 292 T2N0. No patients had pre- or postoperative radio- or chemotherapy. Prognostic significance of the following independent variables was tested using univariate (log-rank) and multivariate (Cox proportional-hazards) analysis: type of resection (sublobar vs lobectomy vs pneumonectomy), histology (squamous cell vs adenocarcinoma), tumour size (<or=3cm vs >3cm), histologic vascular invasion, visceral pleura involvement, positive bronchial resection margin, general T status.
  
  
  RESULTS
  Overall 5-year survival was 63%. In both univariate and multivariate survival analysis, significant prognostic factors were histology (adenocarcinoma 65% vs squamous cell carcinoma 51%), tumour size (<or=3cm 67% vs >3cm 46%), and the presence of negative resection margin. Five-year survival by general T status was 66% in T1N0 vs 55% in T2N0 disease (P=0.19).
  
  
  CONCLUSIONS
  Despite advances in early diagnosis and surgical technique, 5-year survival of stage I non-small cell lung carcinoma remains low as compared to survival of other solid organ neoplasm. Tumour size <or=3cm, adenocarcinoma histologic type and negative bronchial resection margins were associated with a more favourable outcome in our patient population. More effective multimodality treatments are needed to increase survival rates.
authors.affiliation: Department of Thoracic Surgery, University of Torino, San Giovanni Battista Hospital, v. Genova 3, 10126 Turin, Italy. ottavio.rena@tiscalinet.it
authors.forename: Ottavio
authors.initials: O
authors.lastname: Rena
authors.forename: Alberto
authors.initials: A
authors.lastname: Oliaro
authors.forename: Antonio
authors.initials: A
authors.lastname: Cavallo
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.forename: Giovanni
authors.initials: G
authors.lastname: Donati
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Marzio
authors.forename: Giuliano
authors.initials: G
authors.lastname: Maggi
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate