Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung carcinoma.
BACKGROUND
The aim of this study was to clarify preoperative lung function as a prognostic factor for the long-term survival of, and to discuss the appropriateness of lobectomy for, patients with stage I non-small cell lung carcinoma who have poor preoperative pulmonary function.


METHODS
The study group consisted of 402 lobectomized patients with stage I non-small cell lung carcinoma treated by complete resection from 1985 to 1997. Preoperative percent forced vital capacity [(forced vital capacity/predicted forced vital capacity) x 100], FEV(1)% [(forced expiratory volume in 1 second/forced vital capacity) x 100], arterial carbon dioxide tension, and smoking were statistically analyzed as prognostic factors together with other host and tumor biologic factors.


RESULTS
Multivariate analysis demonstrated that tumor size (p < 0.0001) was the most significant prognostic factor for survival from primary lung cancer. Age (p < 0.0001), sex (p = 0.0036), and FEV(1)% (p = 0.0046) were found to be independent prognostic factors for survival from death by nonprimary lung cancer-related causes. Smoking was highly correlated with FEV(1)% (correlation coefficient = -0.511; p < 0.0001). The 100 patients with a preoperative FEV(1)% less than 70% included 34 patients with nonprimary lung cancer-related deaths, whereas the 302 patients with an FEV(1)% of 70% or greater included only 23 patients (p < 0.0001).


CONCLUSIONS
Along with tumor size, FEV(1)% is the most significant prognostic factor for patients with stage I non-small cell lung carcinoma with regard to survival from death by other causes. Lobectomy may not be preferred as an appropriate surgical modality for patients with stage I non-small cell lung carcinoma with small peripheral nodules who exhibit poor pulmonary function, especially lowered FEV(1)%.
Iizasa
Toshihiko
T
Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Suzuki
Makoto
M
Yasufuku
Kazuhiro
K
Iyoda
Akira
A
Otsuji
Mizuto
M
Yoshida
Shigetoshi
S
Sekine
Yasuo
Y
Shibuya
Kiyoshi
K
Saitoh
Yukio
Y
Hiroshima
Kenzo
K
Fujisawa
Takehiko
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000097:blood; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000503:physiopathology* / Q000556:secondary / Q000601:surgery; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D015656:Respiratory Mechanics; D012907:Smoking; D015996:Survival Rate; D014797:Vital Capacity
D002245:Carbon Dioxide