T4 surgery in Non-Small Cell Lung Cancer

Hospes, R.S. (2013) T4 surgery in Non-Small Cell Lung Cancer. thesis, Medicine.

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Abstract

Introduction: Classically, T4 non-small cell lung cancer (NSCLC) is considered unresectable due to growth into mediastinal structures. However, surgery is currently considered in selected patients with a T4N0-1M0 tumor. Although previous studies demonstrate differences in survival of these patients, outcome seems better than with concurrent chemotherapy and radiotherapy. Nevertheless, definitive conclusions are lacking. Aim: The purpose of this study was to assess retrospectively the survival rate and 30-day mortality rate in patients with cT4 NSCLC who underwent surgery in our institution (UMCG; University Medical Center Groningen). Furthermore, we explored whether there are predictive factors responsible for (prolonging) survival. Methods: Out of 816 patients who had surgery for NSCLC between 2001 and 2011, 53 cT4 NSCLC patients were selected. Re-evaluation showed that seven did not fulfill T4N0-1M0 criteria. The database was completed with patient characteristics, comorbidity, complications, 30-day mortality and survival. Subgroups were defined and were based on completeness of resection and additional treatment (induction and/or adjuvant chemotherapy and/or radiotherapy). Survival analysis was performed by a Kaplan-Meier analysis on all subjects and subsequently in subgroups for comparing survival between patient groups. Covariant analysis using Cox-regression was performed to assess independent prognostic factors for survival. Results: In total, 46 patients met the inclusion criteria and could be selected for analysis. Survival analysis showed an overall 1-, 3- and 5-year survival rate for patients with a cT4 tumor of 69%, 45% and 38% respectively with a median survival of 28 months. In subgroups, patients with a complete resection (R0) had a 3-year survival rate of 61% versus 20% in patients having an incomplete resection (R1-2). In patients receiving additional treatment (induction and/or adjuvant) 3-year survival rate was 55% compared to 13% in patients who underwent only surgery. Overall 30-day mortality was 4%. Multivariate analysis showed no significant outcome for any of the investigated variables. Conclusion: Surgical treatment of T4 NSCLC due to invasive tumor growth into the mediastinum provides a longer survival than expected from literature. Therefore, surgery has to be considered in selected patients and can improve survival when performed by experienced surgeons in high-qualified centers.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Groen, Prof. dr. H.J.M. and University Medical Center Groningen Department of Pulmonary
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:52
Last Modified:	25 Jun 2020 10:52
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1319

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