title: Surgical results in T2N0M0 nonsmall cell lung cancer patients with large tumors 5 cm or greater in diameter: what regulates outcome?
abstract: BACKGROUND
  We assessed the surgical results along with the clinical and biological features of nonsmall-cell lung cancer (NSCLC) patients with localized large tumors.
  
  
  METHODS
  The study population consisted of 86 NSCLC patients who underwent complete resection of tumors 5 cm or larger in diameter in stage IB (T2N0M0). We immunohistochemically assessed the expression of angiostatin and endostatin.
  
  
  RESULTS
  The median tumor size was 6.0 cm (range, 5 to 14 cm). The operative procedures used were lobectomy in 71 cases, bilobectomy in 8 cases, and pneumonectomy in 11 cases. Fifty patients (58.1%) relapsed during the mean follow-up period of 33.6 +/- 4.5 months. The median disease-free interval was 9 months. Of 44 recurrent patients whose disease-free interval could be identified, 25 patients (56.8%) relapsed within 12 months after the operation. The overall 5- and 10-year survival rates were 42.0% and 24.2%, respectively. Multivariate analysis showed that the degree of pleural involvement and angiostatin expression within the tumor were independent prognostic indicators. The endostatin expression within tumors also had a weaker relationship with outcome.
  
  
  CONCLUSIONS
  Long-term surgical results were poor and early relapse was common in this cohort. In addition to pleural involvement, the tumor-induced expression of angiostatin and endostatin merit further investigation to gain possible insights into selection of patients who will benefit from surgery as the first line treatment.
authors.affiliation: Department of General and Cardiothoracic Surgery and Pathology, Kanazawa University School of Medicine, Kanazawa, Japan. yohta@med.kanazawa-u.ac.jp
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ohta
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Waseda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Minato
authors.forename: Naoki
authors.initials: N
authors.lastname: Endo
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Isao
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Go
authors.initials: G
authors.lastname: Watanabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D043168:Angiostatins / Q000096:biosynthesis*; D002289:Carcinoma, Non-Small-Cell Lung / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D043169:Endostatins / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000096:biosynthesis*
chemical_list: D043169:Endostatins; D042461:Vascular Endothelial Growth Factor A; D043168:Angiostatins