Long-term survival following pneumonectomy for non-small cell lung cancer: clinical implications for follow-up care.
BACKGROUND
The aim of this study was to determine the risk of overall death in long-term survivors (> 5 years) after pneumonectomy for non-small cell lung cancer (NSCLC), and to establish the optimal follow-up strategy for these patients.


METHODS
We analyzed a single-center experience with 94 long-term survivors who underwent pneumonectomy (group A) for NSCLC between January 1992 and December 2000. Prospective tumor registry data were compared with data for 147 long-term survivors who underwent lobectomy (group B) during the same period.


RESULTS
Clinical characteristics at the time of operation differed between the two groups with more squamous histology, larger tumor size, and more advanced stage in group A compared with group B. During follow-up, late lung cancer relapses were rare in both groups (2.1% vs 1.4%), and second primary malignancies were less frequent in group A (2.1% vs 9.5%, p = 0.032). The overall 10-year survival rate was lower in group A than in group B (67.3% vs 82.8%); however, there was no significant difference in lung cancer-specific survival (93.5% vs 95.1%). Intercurrent disease was the leading cause of death in group A (14 patients, 14.9%), most commonly respiratory failure resulting from community-acquired pneumonia.


CONCLUSIONS
Late cancer relapse or second primary malignancies were rare in long-term survivors after pneumonectomy, but the overall mortality remained high as a result of intercurrent diseases. Continued surveillance should focus on prevention, early detection and aggressive management of intercurrent disease during follow-up care of these patients.
Kim
Dae Joon
DJ
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, CPO Box 8044, Seoul, Republic of Korea.
Lee
Jin Gu
JG
Lee
Chang Young
CY
Park
In-Kyu
IK
Chung
Kyung Young
KY
D000293:Adolescent; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D011013:Pneumonectomy; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data