title: Survival and prognostic factors of surgically resected T4 non-small cell lung cancer.
abstract: BACKGROUND
  Category T4 nonsmall cell lung cancer (NSCLC) encompasses heterogenous subgroups. We retrospectively analyzed the survival of patients with surgically resected T4 NSCLC to evaluate the evidence for prognostic implications according to the subgroups of T4 category, nodal status, and resection completeness.
  
  
  METHODS
  Seventy-six patients with T4N0-2M0 NSCLC were divided into three subgroups within the T4 category: 24 patients with the tumor invading the mediastinal organs (mediastinal group), 16 with a malignant pleural effusion or dissemination (pleural group), and 36 with satellite tumor nodules within the ipsilateral primary tumor lobe (satellite group). Complete resection was possible in 47 patients (61.8%). The pathologic N statuses were N0 in 28, N1 in 13, and N2 in 35 patients.
  
  
  RESULTS
  The overall survival of the 76 patients was 19.1% at 5 years. The overall 5-year survivals according to the three subgroups of the T4 category were as follows: mediastinal group, 18.2%; pleural group, 0%; and satellite group, 26.7% (mediastinal/satellite versus pleural, p = 0.037). Factors significantly influencing the overall 5-year survival were the pathologic N status (N2 versus N0-1, p = 0.022) and the completeness of resection (complete versus incomplete, p = 0.0001). A multivariate survival analysis demonstrated that the pathologic N status and the completeness of resection were significant independent predictors of a poorer prognosis even after adjusting for the subgroup of the T4 category.
  
  
  CONCLUSIONS
  Resectable T4N0-1 NSCLC that is not due to pleural disease deserves consideration of aggressive surgical resection with expected 5-year survival of about 20%.
authors.affiliation: Department of Surgery II, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu, Japan. t-osaki@med.uoeh-u.ac.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Osaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugio
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hanagiri
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Takenoyama
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Yamashita
authors.forename: Masakazu
authors.initials: M
authors.lastname: Sugaya
authors.forename: Manabu
authors.initials: M
authors.lastname: Yasuda
authors.forename: Kosei
authors.initials: K
authors.lastname: Yasumoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010994:Pleura / Q000473:pathology; D016066:Pleural Effusion, Malignant / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011013:Pneumonectomy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate