[Surgical results of T4 lung cancer invading left atrium and great vessels].
OBJECTIVE
To analyzed the indication and prognostic factors of surgical treatment of lung cancer invading left atrium and great vessels (T4).


METHODS
We retrospectively reviewed the database of 136 T4 lung cancer (tumors invading left atrium and great vessels) patients who received surgical treatment in Cancer Hospital of Chinese Academy of Medical Science (CAMS) from September 1981 to January 2007. There are 114 men and 22 women, the median age was 58 years (range 28 - 76). All patients were divided into three subgroups according to the invading site: tumor invading left atrium group, tumor invading superior vena cava group and tumor invading pulmonary artery group. All patients were divided into two subgroups according to the character of operation: complete resection group and incomplete resection group. Patients were divided into three subgroups according to pathological lymph node status: N0, N1 and N2 group.


RESULTS
One hundred and thirty six lung cancer patients received resection of primary lesions plus arterioplasty of pulmonary artery (PA) (n = 83) and/or angioplasty of superior vena cava (SVC) (n = 21) and/or partial resection of left atrium (LA) (n = 32). Complete resection was possible in 120 patients and 16 patients underwent incomplete resection. Five-year survival was 43.0% for entire group, 52. 8% for PA group, 18.2% for SVC group and 18.4% for LA group. Factors significantly influencing the overall 5-year survival were the pathologic N status (5-year survival 15.1% for N2, 5-year survival 44.9% for N1, 5-year survival 74% for N0 group; N2 versus N1 versus N0, P = 0.028) and the completeness of resection (5-year survival 37.5% for complete resection, 5-year survival 22.4% for incomplete resection group; complete versus incomplete, P = 0.042). Pathological lymph node status but not histology and character of operation was an independent prognostic factor using Cox regression analysis (P = 0.01, RR = 1.923, 95% CI: 1.172 -3. 157).


CONCLUSIONS
Pathological lymph node status is an independent prognostic factor for T4 lung cancer. Patients with pathological N0-1 lung cancer invading left atrium and great vessels (T4) may benefit from surgical treatment. In the preoperative workup, every possible effort should be made to achieve a careful evaluation of mediastinal lymph noda status. Compared with incomplete resection group, complete resection group may have a better prognosis. Tumor invading extrapericardial PA may be defined as T2.
Mu
Ju-Wei
JW
Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.
Lü
Fang
F
Wang
Yong-Gang
YG
Li
Jian
J
Mao
You-Sheng
YS
Fang
De-Kang
DK
Liu
Xiang-Yang
XY
Meng
Ping-Jun
PJ
Yang
Lin
L
Cheng
Gui-Yu
GY
Sun
Ke-Lin
KL
Zhang
De-Chao
DC
Zhang
Ru-Gang
RG
Zhang
Da-Wei
DW
Huang
Guo-Jun
GJ
He
Jie
J
D000328:Adult; D000368:Aged; D005260:Female; D006325:Heart Atria; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D011651:Pulmonary Artery / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis; D014683:Vena Cava, Superior / Q000473:pathology