Lobectomy for non-small cell lung carcinoma: a nationwide study of short- and long-term survival.
BACKGROUND
Lobectomy is the standard curative treatment for non-small cell carcinoma (NSCLC) of the lung. Most studies on lobectomy have focused on short-term outcome and 30-day mortality. The aim of this study was to determine both short-term and long-term surgical outcome in all patients who underwent lobectomy for NSCLC in Iceland over a 24-year period.


METHODS
The study involved 489 consecutive patients with NSCLC who underwent lobectomy with curative intent in Iceland, 1991-2014. Patient demographics, pTNM stage, rate of perioperative complications, and 30-day mortality were registered. Overall survival was analyzed with the Kaplan?Meier method. The Cox proportional hazards model was used to evaluate factors that were prognostic of overall mortality. To study trends in survival, the study period was divided into six 4-year periods. The median follow-up time was 42 months and no patients were lost to follow-up.


RESULTS
The average age of the patients was 67 years and 53.8% were female. The pTNM disease stage was IA in 148 patients (30.0%), IB in 125 patients (25.4%), IIA in 96 patients (19.5%), and IIB in 50 patients (10.1%), but 74 (15.0%) were found to be stage IIIA, most often diagnosed perioperatively. The total rate of major complications was 4.7%. Thirty-day mortality was 0.6% (three patients). One- and 5-year overall survival was 85.0% and 49.2%, respectively, with 3-year survival improving from 48.3% to 72.8% between the periods 1991-1994 and 2011-2014 (p = .0004). Advanced TNM stage and age were independent negative prognostic factors for all-cause mortality, and later calendar year and free surgical margins were independent predictors of improved survival.


CONCLUSIONS
The short-term outcome of lobectomy for NSCLC in this population-based study was excellent, as reflected in the low 30-day mortality and low rate of major complications. The long-term survival was acceptable and the overall 3-year survival had improved significantly during the study period.
a Departments of Cardiothoracic Surgery , Landspitali University Hospital , Reykjavik , Iceland.|b Department of Pulmonology , Skåne University Hospital , Lund , Sweden.
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Oskarsdottir
a Departments of Cardiothoracic Surgery , Landspitali University Hospital , Reykjavik , Iceland.
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Halldorsson
a Departments of Cardiothoracic Surgery , Landspitali University Hospital , Reykjavik , Iceland.
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Sigurdsson
a Departments of Cardiothoracic Surgery , Landspitali University Hospital , Reykjavik , Iceland.
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Fridriksson
a Departments of Cardiothoracic Surgery , Landspitali University Hospital , Reykjavik , Iceland.
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Baldvinsson
a Departments of Cardiothoracic Surgery , Landspitali University Hospital , Reykjavik , Iceland.
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Orrason
c Departments of Pulmonology , Landspitali University Hospital , Reykjavik , Iceland.|d Faculty of Medicine , University of Iceland , Reykjavik , Iceland.
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Jonsson
b Department of Pulmonology , Skåne University Hospital , Lund , Sweden.
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Planck
a Departments of Cardiothoracic Surgery , Landspitali University Hospital , Reykjavik , Iceland.|d Faculty of Medicine , University of Iceland , Reykjavik , Iceland.
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Gudbjartsson
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007055:Iceland; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate