Predicting survival following surgery for bronchogenic carcinoma

The value of computed tomography in staging bronchogenic carcinoma: a changing role for mediastinoscopy

Forty-one patients underwent operative staging for bronchogenic carcinoma following computed tomography of the mediastinum between August, 1982, and March, 1984. Twenty-seven patients were classified as Stage I preoperatively; in 2 of them, positive mediastinal nodes were found at thoracotomy. For the 14 patients in whom positive nodes had been identified by computed tomographic (CT) scanning, staging was unchanged as a result of the findings at mediastinoscopy or thoracotomy or both. In this series, computed tomography had a sensitivity of 89%, a specificity of 100%, and an overall accuracy rate of 95%. We conclude that mediastinoscopy is not needed in patients without evidence of mediastinal nodal enlargement by CT scan; when performed, it should be guided toward those nodes identified as positive.

Bronchogenic carcinoma: a study of patients treated at Capital Hospital, Peking, China

From 1961 to 1972, 123 patients with lung cancer underwent operations at Capital Hospital, Peking, China. Ninety-six patients had resectable lesions and 27 did not, a resectability rate of 78%. Four patients (4.2%) died immediately postoperatively. Complications occurred in 8 (8.3%) patients. Five-year survival in this group of 92 survivors was 26 (28.3%). Ten-year survival among 49 patients was 10 (20.4%). Among the 92 five-year survivors, 41.2% had squamous cell carcinoma, 25% had adenocarcinoma, and 16% had undifferentiated carcinoma. Patients with squamous cell carcinoma had a much longer survival than the others. Six factors appear to influence survival after resection: cell type, presence of lymph node metastases, presence of tumor emboli in blood vessels, sex, age, and location. Men about 50 years of age, with a peripherally located squamous cell tumor and with no tumor emboli or lymph node metastases, have a good chance of surviving a pulmonary resection for ten years.

Bronchiolar carcinoma: report of 11 cases and review of the literature

Eleven cases of bronchiolar carcinoma seen between 1970 and 1975 are reviewed. Roentgenographic manifestations at the time of initial examination included single peripheral nodules, multiple nodules, irregular cavities and a persistent infiltrative form. Microscopic tissue examinations showed two patterns of tumor growth: a papillary form resembling tall columnar cells extending along but not invading the alveolar septal walls and a cribriform pattern represented by inflammatory thickening of the alveolar septal walls and pleomorphic cellular proliferation within luminal spaces. The papillary form was associated with the cavitary lesions. Long term survival is dependent on early recognition of the single peripheral nodule, cavity or small persistent infiltrative form managed by a thoracotomy and lobectomy.

Major pulmonary resection for bronchogenic carcinoma in the elderly

The results of major pulmonary resection in 58 patients greater than 70 years of age were reviewed. The histological distribution and extent of nodal metastases in this age group are the same as in younger patients. The absolute five-year survival rate for the 55 patients undergoing curative resection was 30% (17 patients). It was 36% (11 patients) for those patients with squamous cell carcinoma and 22% (5 patients) for those with adenocarcinoma. The operative mortality was only 14% (8 patients). Of the 49 patients treated by lobectomy, 17 lived five years or more free of disease, whereas none of the 6 patients treated by pneumonectomy survived five years. The five-year survival rate of 30% in this series of elderly patients treated by major pulmonary resection makes resections in such patients with bronchogenic carcinoma worthwhile.

Carcinoma of the lung: results of treatment over ten years

Mediastinal lymph node dissection in conjunction with pulmonary resection was performed on 437 patients with bronchogenic carcinoma at the University of Michigan Medical Center from 1959 to 1969. The absolute five- and ten-year survival rates for patients undergoing curative resection were 36.2 and 14.4%, respectively. The five-year survival of those without nodal metastases was 49.3%, and it was 31.1% in patients with hilar metastases only. The five-year survival of patients with mediastinal metastases who received radiation therapy was 23.1%. Of the 193 patients with squamous cell carcinoma, 43% lived five years free from disease. The five-year survival of patients undergoing resection who had no hilar lymph node metastases was 53%, and it was 47.5% in those with hilar metastases only. The five-year survival in patients with mediastinal metastases who received postoperative irradiation was 34.4%.