title: [pT4 non-small cell lung cancer: Surgical characteristics in present practice].
abstract: BACKGROUND
  pT4 is a group of miscellaneous tumors: our goal was to revisit their surgical reality.
  
  
  METHODS
  The different characteristics and prognostic factors of lung pT4 (n=403) were analysed according to three subgroups: G1 - by direct extension; G2 - by nodule in other ipsilateral lobe; G3 - because of both.
  
  
  RESULTS
  There were 332 males and 71 females mean aged 61.5 years. Surgery [exploratory: 89 (22.1 %), lobectomy: 149 (37 %), pneumonectomy: 169 (41.9 %)] was followed by 26 postoperative deaths (6.5 %), 82 complications (20.3 %) and concerned few pN0 (47.6 %). G1 (n=196) and G3 (n=53) were not different. By comparison with them, G2 (n=53) were mainly females (24\13 %), with less explorative thoracotomy (2.6\34 %), more complete R0 resections (77\29 %), less pneumonectomy (31\47 %), more small sized tumors (mean: 37\57 mm), more adenocarcinoma (67\32 %), more N0 tumors (48\31.7 %) and stages IIIA disease (46.7\56 %). G2 5-year survival rates were higher (G2: 22 %; G1: 13 %; G3: 15 %); G1 rates depended of the invaded structure (20.9 % for the vertebra down to 0 % for the esophagus and carina). pN2 rates were not very high but not different between groups (G1: 13.6 %; G2: 15.6 %; G3: 14.3 %; P=0.52). Multivariate analysis demonstrated completeness and type of resection, stage and age as independent factors of prognosis.
  
  
  CONCLUSIONS
  Surgery for pT4 is justified provided rigorous selection of extension forms. However, assimilating extension and ipsilateral lobe nodule in a same group does not obey to surgical reality.
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Rivera
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Pricopi
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France.
authors.forename: W
authors.initials: W
authors.lastname: Borik
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Foucault
authors.affiliation: Centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France.
authors.forename: A
authors.initials: A
authors.lastname: Dujon
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Le Pimpec Barthes
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France. Electronic address: marc.riquet@egp.aphp.fr.
authors.forename: M
authors.initials: M
authors.lastname: Riquet
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / 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 / Q000706:statistics & numerical data; D011364:Professional Practice / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Cancer du poumon non à petites cellules; Chirurgie; Non-small cell lung cancer; PT4; Surgery; TNM