Prognostic factors and survival in patients undergoing surgery for T4 nonsmall cell lung carcinoma.
BACKGROUND
Surgical treatment of T4 non-small cell lung carcinoma (NSCLC) is controversial.


METHODS
Between 1998 and 2011, 70 patients undergoing pulmonary resection for T4 NSCLC were evaluated. The patients were divided into four groups: the large vessels group (n = 28), the carinal group (n = 20), the separate tumor nodules group (n = 13) and the mediastinal fat group (n = 9).


RESULTS
Overall mortality and morbidity were 12.9% (n = 9) and 35.7% (n = 25), respectively and there was no significant differences between the four groups (p = 0.961, p = 0.750). Complete resection was possible in 47 patients (67.1%). The pathological nodal status was as follows: N0/1 in 58 patients and N2 in 12 patients. Five-year survival rate was 28.9% for all patients and 49.6%, 18.5%, 0% and 20.5% in the carinal, large vessels, mediastinal fat and separate tumor nodule groups, respectively. The carinal group was significantly different from the other groups in terms of survival (p = 0.05). By multivariate analysis, only two factors significantly and independently influenced survival: nodal status (N0/N1 versus N2; p = 0.01) and complete resection (R0 versus R1; p = 0.06).


CONCLUSIONS
Resection is not a suitable approach for T4 NSCLC patients with N2 disease or incomplete resection. Resectable T4 NSCLC patients with carinal or tracheal involvement have better survival than do other T4 sub-groups.
N
N
Citak
S
S
Büyükkale
A
A
Sayar
M
M
Metin
A
A
Pekçolaklar
A
A
Gürses
D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014421:Turkey / Q000453:epidemiology