Pneumonectomy for stage I (T1N0 and T2N0) nonsmall cell lung cancer has potent, adverse impact on survival

Background. Surgically treated, stage I (T1N0 and T2N0) nonsmall cell lung cancer has a relatively favorable prognosis. Our aim was to determine whether performing a pneumonectomy in this group of patients has an impact on survival. Methods. Four hundred eighty-five patients with stage I nonsmall cell lung cancer undergoing lung resection between 1991 and 2000 were studied. Three hundred seventy-four patients underwent a smaller resection than a pneumonectomy and 111 had a pneumonectomy. Results. Patients undergoing less extensive resections were older (mean age, 65 vs 63 years) (p = 0.01); these patients were also more likely to have a history of chronic obstructive airway disease (9% vs 2%) (p = 0.01) or asthma (10% vs 3%) (p = 0.04), nonsquamous cell type (56% vs 27%) (p < 0.0001), and T1 tumor stage (66% vs 17%) (P = 0.002) than patients having a pneumonectomy. Operative mortality was 2.4% versus 8% (p = 0.01). Overall 1-, 3-, and 5-year Kaplan-Meier survival rates (95% confidence interval [CI]) after less extensive resections were 85% (CI, 82% to 90%), 63% (CI, 56% to 69%), and 50% (CI, 42% to 57%), respectively, and after pneumonectomy the survival rates were 66% (CI, 53% to 73%), 47% (CI, 35% to 57%), and 44% (CI, 32% to 55%), respectively (p = 0.0006). When the Cox proportional hazards model was applied to all study patients (n = 485), pneumonectomy (p = 0.001), T2 stage (p = 0.006), older age (p = 0.03), and male gender (p = 0.03) were independent adverse predictors of survival. When the analysis was limited to the patients having T1N0 disease (n = 145), pneumonectomy (p = 0.0008), older age (p = 0.05), and nonsquamous cell type (p = 0.02) were independent adverse determinants of survival. When only the patients with T2N0 disease were analyzed (n = 340), male gender (p = 0.0005) and pneumonectomy (p = 0.01) were independent negative predictors of survival. Conclusions. In this study, the patients who underwent pneumonectomy for stage T1N0 or T2N0 nonsmall cell lung cancer had a significantly poorer survival than those patients who underwent smaller lung resections. (C) 2003 by The Society of Thoracic Surgeons.