title: Marginal pulmonary function should not preclude lobectomy in selected patients with non-small cell lung cancer.
abstract: OBJECTIVE
  Current clinical trials are investigating the role of stereotactic body radiation therapy (SBRT) versus sublobar resection for patients with non-small cell lung carcinoma (NSCLC) and marginal pulmonary function tests (M-PFTs). We compared the outcomes of patients undergoing lobectomy with M-PFTs characterized by 2 accepted M-PFT criteria.
  
  
  METHODS
  A total of 1,259 consecutive patients underwent lobectomy for NSCLC between 1999 and 2011. Patients were stratified into 2 classifications of M-PFT: American College of Surgeons Oncology Group (ACOSOG) Z4099/Radiation Therapy Oncology Group (RTOG) 1021 trial or American College of Chest Physicians (ACCP) criteria. There were 206 patients classified as having M-PFT according to ACOSOG Z4099/RTOG 1021 criteria and 131 patients classified as having M-PFT by ACCP criteria. The primary endpoints of the study were post-operative complications and survival.
  
  
  RESULTS
  Median follow-up was 3.8 years. Cox-proportional survival analysis found that pathologic stage (P < .001), age (P < .001), and higher Zubrod functional status (P < .001) were independent predictors of mortality. Using multivariable analysis for major morbidity, M-PFT status was not associated with the development of a major complication following lobectomy (P = .68). M-PFT classification was not an independent predictor of mortality when controlling for other variables (ACOSOG Z4099/RTOG 1021 [P = .34]; ACCP criteria [P = .83]). A composite major morbidity analysis for major morbidity following lobectomy showed no association between clinicopathologic variables or M-PFTs and the occurrence of a major postoperative morbidity.
  
  
  CONCLUSIONS
  In carefully selected patients with M-PFTs, lobectomy for NSCLC can be performed with acceptable morbidity and mortality. These results need to be considered when deciding if a patient should undergo lobectomy or other therapies for resectable NSCLC.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Taylor
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
authors.forename: James M
authors.initials: JM
authors.lastname: Isbell
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Lau
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: jonesd2@mskcc.org.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: 10; ACCP; ACSOG; American College of Chest Physicians; American College of Surgeons Oncology Group; CT; DLCO; FEV1; M-PFT; NSCLC; RFA; RTOG; Radiation Therapy Oncology Group; SBRT; STS; The Society of Thoracic Surgeons; computed tomography; diffusing capacity for carbon monoxide; forced expiratory volume in 1 second; marginal pulmonary function test; non–small cell lung carcinoma; radiofrequency ablation; stereotactic body radiotherapy