Objective: To evaluate the effect of comorbidity as an independent prognostic factor in lung cancer. Method: Data on 2991 consecutive cases of lung cancer were collected prospectively from 19 Spanish ...hospitals between 1993 and 1997 by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S). To evaluate the effect of comorbidity on survival, 1121 patients with non-small cell lung cancer (NSCLC) in pathological stage I who underwent complete resection were selected, excluding operative mortality. The presence of specific comorbidities at the time of thoracotomy was registered prospectively. Results: Cox regression analysis showed that tumour size (0–2, 2–4, 4–7, >7 cm) (HR 1.45 95% CI 1.08 to 1.95), 1.86 (95% CI 1.38 to 2.51), 2.84 (95% CI 1.98 to 4.08)), the presence of a previous tumour (HR 1.45 (95% CI 1.17 to 1.79)) and age (HR 1.02 (95% CI 1.01 to 1.03)) had a significant prognostic association with survival. This study excluded the presence of visceral pleural involvement or other comorbidities as independent variables. Conclusion: The presence of a previous tumour is an independent prognostic factor in pathological stage I NSCLC with complete resection, increasing the probability of death by 1.5 times at 5 years. It is independent of other comorbidities, TNM classification and age.
a H. Universitari Germans Trias i Pujol, Carretera de Canyet s/n 08916 Badalona, Barcelona, Spain
b School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
*Corresponding ...author. Tel.: +34 934978921; fax: +34 934978843. E-mail address : esther_med2000{at}yahoo.es (E. Fernández).
The incidence of lung cancer has been increasing in developed countries since the mid-1990s. The main objective of this study is to determine if bronquial stump infiltration can affect survival in patients with lung cancer. For this purpose, we differentiate between carcinoma in situ and invasive carcinoma. We included patients suffering from non-small cell lung cancer who underwent thoracothomy as treatment. The total number of patients was 2994. In this study, 80 patients out of the 2994 had bronchial stump affection. Eight patients were excluded thus a total of 72 patients were included, 52 of them had carcinoma in situ and 20 invasive carcinoma. The global survival was 25 months. Patients with carcinoma in situ had a median survival of 25 months as opposed to 21 months in patients with invasive carcinoma. We only found statistical significance when we compared the histology with the type of bronchial stump infiltration. We did not observe statistical significance in survival between carcinoma in situ and invasive carcinoma bronchial stump infiltration ( P =0.094). The only survival predictor variable is histology (adenocarcinoma), P =0.0001.
Key Words: Lung cancer; Stump bronchial affection; Carcinoma in situ
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eComment: Therapeutic options for bronchial stump infiltration following lung cancer surgery
Nikolaos Barbetakis, C. Asteriou, A. Kleontas, and C. Tsilikas
Interactive CardioVascular and Thoracic Surgery 2009 9: 186.
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Analizar la morbilidad y mortalidad asociadas a la cirugía de exéresis pulmonar por carcinoma broncogénico, como parámetros definitorios del riesgo inherente a este tratamiento.
Estudio prospectivo y ...multicéntrico, realizado en los 19 hospitales integrantes del Grupo Cooperativo de Carcinoma Broncogénico entre el 1 de octubre de 1993 y el 30 de septiembre de 1997. En este tiempo fueron sometidos a toracotomía 2.994 pacientes con carcinoma broncogénico. La morbilidad y mortalidad a los 30 días se recogieron mediante un registro de datos unificado para todos los hospitales.
Se practicaron 2.491 exéresis mayores y 212 menores. Se precisó resección extendida en 296 pacientes, mientras que en 291 se efectuó toracotomía exploradora.
En 1.057 pacientes (35,2%) se objetivaron complicaciones postoperatorias, de las que las más frecuentes fueron las relacionadas directamente con la intervención quirúrgica (22,9%), seguidas por las respiratorias (19,5%) y las cardiovasculares (10,7%). En 654 casos (21,8%) las complicaciones fueron de carácter único, mientras que 403 (13,4%) presentaron más de una. Atendiendo a su categoría, el 21 % de las complicaciones fueron menores, en tanto que las complicaciones mayores sucedieron en el 14,2 % de los casos.
El análisis de la mortalidad en los 30 primeros días mostró una incidencia del 6,8% (204 pacientes), y estuvo notablemente vinculada con la aparición de complicaciones mayores (40,8%).
En nuestro medio el tratamiento quirúrgico del carcinoma broncogénico genera una morbilidad y una mortalidad elevadas, en el rango de las habitualmente referidas en relación con la morbilidad y en el límite alto cuando se considera la mortalidad. La presencia de complicaciones mayores y/o su multiplicidad deben considerarse elementos sus-tancialmente moduladores del incremento del riesgo.
TO analyze the factors that determine the risk of morbidity and mortality associated with lung resection in patients with bronchogenic carcinoma.
Prospective multicenter study conducted between October 1, 1993 and September 30, 1997 in the 19 hospitals that make up the Bronchogenic Carcinoma Cooperative Group. During the study period, 2994 patients with bronchogenic carcinoma underwent surgery. The morbidity and mortality data at 30 days from all centers were recorded in a single registry.
Major resection was performed in 2491 patients, whereas 212 underwent minor resection. The resection had to be extended in 296 and exploratory thoracotomy was carried out in 291. Postoperative complications were reported in 1057 patients (35.2%).
Complications directly related to surgery were the most common (22.9%), followed by respiratory (19.5%) and cardiovascular (10.7%) complications. Of the patients with complications, 654 patients (21.8%) had only 1, whereas 403 (13.4%) had more than 1. After classification of complications, 21% were found to be minor and 14.2% were major. Mortality at 30 days was 6.8% (204 patients), and strongly linked to the presentation of major complications—40.8% of those with such complications died
Surgical treatment of bronchogenic carcinoma in Spain is associated with high morbidity and mortality. The morbidity reported in the present study lies in the middle of the ranges found in the literature, whereas mortality lies at the high end of the range. The presence of major complications and/or multiple complications should be considered as strong risk factors.
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