title: Prognostic factors for survival after complete resections of synchronous lung cancers in multiple lobes: pooled analysis based on individual patient data.
abstract: BACKGROUND
  Some reports suggest that patients with synchronous multiple foci of nonsmall-cell lung cancers (NSCLC) distributed in multiple lobes have a poor prognosis, even when there is no extrathoracic metastasis. The vast majority of such patients do not receive surgical treatment. For those who undergo surgery, prognostic factors are unclear.
  
  
  METHODS
  We systematically reviewed the literature on surgery for synchronous NSCLC in multiple lobes published between 1990 and 2011. Individual patient data were used to obtain adjusted hazard ratios (HRs) in each dataset and pooled analyses were carried out.
  
  
  RESULTS
  Six studies contributed 467 eligible patients for analysis. The median overall survival was 52.0 months [95% confidence interval 45.6-63.7]. Male gender and advanced age were associated with a decreased survival: HRs 1.64 (1.22, 2.22) and 1.40 (1.20, 1.80) per 20-year increment, respectively. Patients with cancers distributed in one lung had a higher mortality risk than those with bilateral disease: HRs 1.45 (1.06, 2.00). N1 or N2 had a decreased survival compared with N0: HRs 1.68 (1.12, 2.51) and 1.94 (1.33, 2.82), respectively. There was a trend toward increased mortality among patients with different histology: HRs 1.29 (0.96, 1.75).
  
  
  CONCLUSIONS
  Advanced age, male gender, nodal involvement, and unilateral tumor location were poor prognostic factors.
authors.affiliation: Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa,FL 33612, USA.
authors.forename: T
authors.initials: T
authors.lastname: Tanvetyanon
authors.forename: D J
authors.initials: DJ
authors.lastname: Finley
authors.forename: T
authors.initials: T
authors.lastname: Fabian
authors.forename: M
authors.initials: M
authors.lastname: Riquet
authors.forename: L
authors.initials: L
authors.lastname: Voltolini
authors.forename: C
authors.initials: C
authors.lastname: Kocaturk
authors.forename: W J
authors.initials: WJ
authors.lastname: Fulp
authors.forename: R J
authors.initials: RJ
authors.lastname: Cerfolio
authors.forename: B J
authors.initials: BJ
authors.lastname: Park
authors.forename: L A
authors.initials: LA
authors.lastname: Robinson
mesh_terms: D000367:Age Factors; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012737:Sex Factors; D016896:Treatment Outcome