The side of pneumonectomy influences long-term survival in stage I and II non-small cell lung cancer

BACKGROUND

The impact of pneumonectomy as an independent factor on long-term survival after lung resection for centrally or locally advanced non-small cell lung cancer (NSCLC) remains controversial. The aim of this paper is to study the impact of pneumonectomy, and the influence of side of surgery, on long-term survival in patients with pathologic stage I and II NSCLC.

METHODS

A retrospective review of a prospective multi-institutional database of patients operated on for lung cancer was undertaken. In all, 1,475 patients with pathologic stage I or II NSCLC were studied (421 underwent pneumonectomy; 1,054 had a lobectomy/bilobectomy). Survival and impact of side of surgery for pneumonectomy and lesser resection groups were analyzed and compared using the Kaplan-Meier method and the Cox proportional hazards model.

RESULTS

Median survival was worse after pneumonectomy than after less extensive resections for patients overall (33 versus 57 months) and for those with stage I NSCLC (38 versus 70 months); however, median survival was better after pneumonectomy for stage II left tumors (55 versus 19 months). Pneumonectomy was an independent adverse determinant of survival for both stage I right tumors (p < 0.001) and stage I left tumors (p < 0.001), but was associated with improved survival for stage II left tumors (p = 0.009).

CONCLUSIONS

Pneumonectomy was found to be an independent determinant of survival in patients with stage I and II NSCLC, but results differed for right- and left-sided tumors. Further studies of survival comparing pneumonectomy with lesser resections should differentiate between right and left procedures.

[Trends in lung cancer mortality rates in the provinces of Andalusia, Spain, 1975-2002]

OBJECTIVE

To describe trends in lung cancer mortality rates in the different provinces of Andalusia, Spain, from 1975 through 2002.

MATERIAL AND METHODS

Deaths from lung cancer during the period 1975 through 2002 were obtained from the Spanish national institute of statistics. Crude rates and age-adjusted rates (overall and truncated 35-64 year rates) were calculated.

RESULTS

In Andalusia in 2002 there were 2802 deaths from lung cancer in men and 254 in women, representing 28.4% and 4.5%, respectively, of the mortality rate from tumors. Joinpoint regression analysis distinguished 3 recent trends in truncated (range, 35-64 years) lung cancer mortality rates in men: decrease in Sevilla, increase in Huelva and Jaen, and stability in the other provinces. For women there was a marked increase (5.2% annually) during the period 1988 through 2002 in Malaga.

CONCLUSIONS

From a strategic point of view, antismoking strategies should target women in the province of Malaga in particular, with the aim of detaining their increasing risk for this type of cancer and of preventing avoidable and premature deaths among future generations of women.

Epidemiology of Lung Cancer in Spain and Forecast for the Future

Lung cancer, a steadily growing problem, ranks as the first cause of tumor-related deaths in developed countries. The relation between lung cancer and smoking makes it a potentially avoidable disease. Found mainly in men, it has made alarming gains among women. The main prognostic factor is the possibility of receiving curative surgery; however, in real practice the diagnosis usually comes when the disease has reached an advanced stage, when only 20% can be treated surgically. Nonsurgical treatments based on chemo- and radiotherapy have not advanced appreciably in recent years, and 5-year survival is poor, estimated at only around 7% to 12% in Spain. Attempts must be made to improve preventive measures and early diagnosis in order to improve the prognosis for lung cancer patients.