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J Thorac Cardiovasc Surg 1995;109:120-129
© 1995 Mosby, Inc.

GENERAL THORACIC SURGERY

Incidence of local recurrence and second primary tumors in resected stage I lung cancer

New York, N.Y.

Address for reprints: N. Martini, MD, 1275 York Ave., New York, NY 10021.

Abstract

From 1973 to 1985, 598 patients underwent resection for stage I non-small-cell lung cancer. There were 291 T1 lesions and 307 T2 lesions. The male/female ratio was 1.9:1. The histologic type was squamous carcinoma in 233 and nonsquamous carcinoma in 365. Lobectomy was performed in 511 patients (85%), pneumonectomy in 25 (4%), and wedge resection or segmentectomy in 62 (11%). A mediastinal lymph node dissection was carried out in 560 patients (94%) and no lymph node dissection in 38 (6%). Fourteen postoperative deaths occurred (2.3%). Ninety-nine percent of the patients were observed for a minimum of 5 years or until death with an overall median follow-up of 91 months. The overall 5- and 10-year survivals (Kaplan-Meier) were 75% and 67%, respectively. Survival in patients with T1 N0 tumors was 82% at 5 years and 74% at 10 years compared with 68% at 5 years and 60% at 10 years for patients with T2 tumors (p < 0.0004). The overall incidence of recurrence was 27% (local or regional 7%, systemic 20%) and was not influenced by histologic type. Second primary cancers developed in 206 patients (34%). Of these, 70 (34%) were second primary lung cancers. Despite complete resection, 31 of 62 patients (50%) who had wedge resection or segmentectomy had recurrence. Five- and 10-year survivals after wedge resection or segmentectomy were 59% and 35%, respectively, significantly less than survivals of those undergoing lobectomy (5 years, 77%; 10 years, 70%). The 5- and 10-year survivals in the 38 patients who had no lymph node dissection were reduced to 59% and 32%, respectively. Apart from the favorable prognosis observed in this group of patients, three facts emerge as significant: (1) Systematic lymph node dissection is necessary to ensure that the disease is accurately staged; (2) lesser resections (wedge/segment) result in high recurrence rates and reduced survival regardless of histologic type; and (3) second primary lung cancers are prevalent in long-term survivors. (J THORAC CARDIOVASC SURG 1995;109:120-9)

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				Y. Ichinose, K. Genka, T. Koike, H. Kato, Y. Watanabe, T. Mori, S. Iioka, A. Sakuma, and M. Ohta Randomized Double-Blind Placebo-Controlled Trial of Bestatin in Patients With Resected Stage I Squamous-Cell Lung Carcinoma J Natl Cancer Inst, April 16, 2003; 95(8): 605 - 610. [Abstract] [Full Text] [PDF]

				W. Sienel, R. Seen-Hibler, W. Mutschler, K. Pantel, and B. Passlick Tumour cells in the tumour draining vein of patients with non-small cell lung cancer: detection rate and clinical significance Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 451 - 456. [Abstract] [Full Text] [PDF]

				S. V. Harden, Y. Tokumaru, W. H. Westra, S. Goodman, S. A. Ahrendt, S. C. Yang, and D. Sidransky Gene Promoter Hypermethylation in Tumors and Lymph Nodes of Stage I Lung Cancer Patients Clin. Cancer Res., April 1, 2003; 9(4): 1370 - 1375. [Abstract] [Full Text] [PDF]

				T. Sioris, R. Jarvenpaa, P. Kuukasjarvi, H. Helin, S. Saarelainen, and M. Tarkka Comparison of computed tomography and systematic lymph node dissection in determining TNM and stage in non-small cell lung cancer Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 403 - 408. [Abstract] [Full Text] [PDF]

				M. Maddaus Safe harbor J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 454 - 455. [Full Text] [PDF]

				N. Kikuchi, H. Satoh, K. Sekizawa, and S. Ishikawa Late recurrence after resection of stage I lung adenocarcinoma Ann. Thorac. Surg., March 1, 2003; 75(3): 1069 - 1070. [Full Text] [PDF]

				S. J. Swensen, J. R. Jett, T. E. Hartman, D. E. Midthun, J. A. Sloan, A.-M. Sykes, G. L. Aughenbaugh, and M. A. Clemens Lung Cancer Screening with CT: Mayo Clinic Experience Radiology, March 1, 2003; 226(3): 756 - 761. [Abstract] [Full Text] [PDF]

				F. M.A. Melfi, A. Chella, G. F. Menconi, F. Givigliano, G. Boni, G. Mariani, P. Sbragia, and C. A. Angeletti Intraoperative radioguided sentinel lymph node biopsy in non-small cell lung cancer Eur. J. Cardiothorac. Surg., February 1, 2003; 23(2): 214 - 220. [Abstract] [Full Text] [PDF]

				M. Higashiyama, K. Kodama, K. Takami, N. Higaki, T. Nakayama, and H. Yokouchi Intraoperative lavage cytologic analysis of surgical margins in patients undergoing limited surgery for lung cancer J. Thorac. Cardiovasc. Surg., January 1, 2003; 125(1): 101 - 107. [Abstract] [Full Text] [PDF]

				R. L. Quarterman, A. McMillan, M. B. Ratcliffe, and M. I. Block Effect of preoperative delay on prognosis for patients with early stage non-small cell lung cancer J. Thorac. Cardiovasc. Surg., January 1, 2003; 125(1): 108 - 114. [Abstract] [Full Text] [PDF]

				G. Sutedja New techniques for early detection of lung cancer Eur. Respir. J., January 1, 2003; 21(39_suppl): 57S - 66s. [Abstract] [Full Text] [PDF]

				M. S. Brown, J. G. Goldin, R. D. Suh, M. F. McNitt-Gray, J. W. Sayre, and D. R. Aberle Lung Micronodules: Automated Method for Detection at Thin-Section CT--Initial Experience Radiology, January 1, 2003; 226(1): 256 - 262. [Abstract] [Full Text] [PDF]

				N. Sawabata, A. Matsumura, M. Ohota, H. Maeda, H. Hirano, K. Nakagawa, and H. Matsuda Cytologically malignant margins of wedge resected stage I non-small cell lung cancer Ann. Thorac. Surg., December 1, 2002; 74(6): 1953 - 1957. [Abstract] [Full Text] [PDF]

				R. J. Battafarano, B. F. Meyers, T. J. Guthrie, J. D. Cooper, and G. A. Patterson Surgical resection of multifocal non-Small cell lung cancer is associated with prolonged survival Ann. Thorac. Surg., October 1, 2002; 74(4): 988 - 994. [Abstract] [Full Text] [PDF]

				R.-S. Lai, J.-S. Wang, H.-K. Hsu, H.-C. Chang, C.-H. Lin, and M.-H. Lin Prognostic Evaluation of the Expression of p53 and bcl-2 Oncoproteins in Patients with Surgically Resected Non-small Cell Lung Cancer Jpn. J. Clin. Oncol., October 1, 2002; 32(10): 393 - 397. [Abstract] [Full Text] [PDF]

				L. J. Daniels, S. S. Balderson, M. W. Onaitis, and T. A. D'Amico Thoracoscopic lobectomy: a safe and effective strategy for patients with stage i lung cancer Ann. Thorac. Surg., September 1, 2002; 74(3): 860 - 864. [Abstract] [Full Text] [PDF]

				T. Osaki, T. Oyama, C.-D. Gu, T. Yamashita, T. So, M. Takenoyama, K. Sugio, and K. Yasumoto Prognostic Impact of Micrometastatic Tumor Cells in the Lymph Nodes and Bone Marrow of Patients With Completely Resected Stage I Non-Small-Cell Lung Cancer J. Clin. Oncol., July 1, 2002; 20(13): 2930 - 2936. [Abstract] [Full Text] [PDF]

				K. Hiroshima, A. Iyoda, K. Shibuya, T. Toyozaki, Y. Haga, T. Fujisawa, and H. Ohwada Prognostic significance of neuroendocrine differentiation in adenocarcinoma of the lung Ann. Thorac. Surg., June 1, 2002; 73(6): 1732 - 1735. [Abstract] [Full Text] [PDF]

				H. T. Winer-Muram, S. G. Jennings, R. D. Tarver, A. M. Aisen, M. Tann, D. J. Conces, and C. A. Meyer Volumetric Growth Rate of Stage I Lung Cancer prior to Treatment: Serial CT Scanning Radiology, June 1, 2002; 223(3): 798 - 805. [Abstract] [Full Text] [PDF]

				A.E. Martin-Ucar, N. Chaudhuri, J.G. Edwards, and D.A. Waller Can pneumonectomy for non-small cell lung cancer be avoided? An audit of parenchymal sparing lung surgery Eur. J. Cardiothorac. Surg., April 1, 2002; 21(4): 601 - 605. [Abstract] [Full Text] [PDF]