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J Thorac Cardiovasc Surg 2007;134:638-643
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Prognostic factors in resected stage I non–small cell lung cancer with a diameter of 3 cm or less: Visceral pleural invasion did not influence overall and disease-free survival

^a Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
^b Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Received for publication December 12, 2006; revisions received April 5, 2007; accepted for publication April 11, 2007.

^_* Address for reprints: Yu-Chung Wu, MD, No. 201, Section 2, Shih-Pai Road, Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan. (Email: wuyc{at}vghtpe.gov.tw).

Objective: Resection is the treatment of choice for patients with stage I non–small cell lung cancer. Stage I non–small cell lung cancer has been further subdivided into IA (T1N0M0, tumor size 3 cm without visceral pleural invasion) and IB (T2N0M0, tumor size > 3 cm or any size with visceral pleural invasion). The aim of this study was to evaluate the prognostic factors in patients with resected stage I non–small cell lung cancer with a diameter of 3 cm or less.

Methods: We retrospectively reviewed the clinicopathologic characteristics of 445 patients with resected stage I non–small cell lung cancer with a diameter of 3 cm or less who were treated at Taipei Veterans General Hospital between 1980 and 2000. Disease-free survival, overall survival, and their predictors were analyzed.

Results: The 5- and 10-year overall survivals were 61.4% and 40.0%, respectively. The 5- and 10-year disease-free survivals were 74.5% and 73.4%, respectively. Tumor size, smoking index, and number of mediastinal lymph nodes dissected were significant predictors for both disease-free survival (P = .009, P = .002, and P = .006, respectively) and overall survival (P = .004, P < .001, and P = .001, respectively) in multivariate analyses. Visceral pleural invasion did not influence overall survival or disease-free survival.

Conclusions: Tumor size, smoking index, and number of mediastinal lymph nodes dissected were prognostic factors for both overall survival and disease-free survival in resected stage I non–small cell lung cancer with a diameter of 3 cm or less. Small tumors (<3 cm) of stage IB (T2N0M0) non–small cell lung cancer with visceral pleural invasion should be treated as T1 disease and not T2 disease.