Factors predicting poor survival after resection of stage IA non-small cell lung cancer

Objective: Using a national cancer registry, we determined the postoperative survival of patients with stage IA non-small cell lung cancer in the United States from 1988 to 1997 and identified factors that affect survival. Methods: Within the Surveillance, Epidemiology, and End Result Program database, 10,761 patients were identified as having stage IA non-small cell lung cancer and underwent curative surgical resection from 1988 to 1997. Univariate analyses were performed by the log-rank test to determine predictors of survival, and multivariable analysis was performed by a Cox regression model. Results: Overall 5-year survival was 58%. On univariate analysis, tumor size, gender, age, and extent of resection were significant predictors of survival. Five-year survival of patients with tumors 2.1 to 3.0 cm was lower than that for patients with tumors 2.0 cm or smaller: 55% versus 60% (P < .0001). Men faired significantly worse than women, with a 5-year survival of 53% versus 63% (P < .0001). Patients older than the median age of 67 years had worse 5-year survival than had those under the median age: 52% versus 65% (P < .0001). Patients undergoing sublobar resections showed poorer 5-year survival than patients undergoing anatomic resections: 44% versus 61% (P < .0001). On multivariable analysis with a Cox regression model, all 4 variables remained statistically significant. Conclusion: The survival of patients with stage IA non-small cell lung cancer within the United States is significantly worse than survival reported from single-institution studies. This study identifies 4 factors that may affect survival in resected stage IA non-small cell lung cancer: tumor size, gender, age, and extent of resection.