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J Thorac Cardiovasc Surg 2007;134:850-856
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

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

^a Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, and Boston VA Healthcare, Harvard School of Public Health, Boston, Mass
^b Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
^c Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication September 17, 2006; revisions received February 26, 2007; accepted for publication March 8, 2007.

^_* Address for reprints: Michael Y. Chang, MD, MPH, 4760 Sunset Blvd., 3rd Floor, Los Angeles, CA 90027. (Email: Michael.Y.Chang{at}kp.org).

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.

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Discussion
J. Thorac. Cardiovasc. Surg. 2007 134: 856. [Extract] [Full Text] [PDF]