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Background: In patients with early-stage nonsmall cell lung cancer treatment selection is rarely assessed. Many surgical papers report only the outcome of patients who underwent surgery although selection may influence the outcome. In this report, treatment selection and the outcome of both surgically and nonsurgically treated patients is evaluated., Methods: Three hundred sixty patients (269 surgically treated and 91 nonsurgically treated) with clinical stage I and II were included. Risk factors were scaled according to the Charlson comorbidity index (CCI). Hospital morbidity and long-term survival were evaluated., Results: Mean age was 64 years for the surgical and 74 for the nonsurgical patients. Mean CCI score was 1.3 and 2.4, and 5-year survival was 47% and 3%, respectively. Male sex, pneumonectomy, and CCI score of 3 or more were predictive for major postoperative complications. For the nonsurgical patients receiving radiotherapy, the 2-year survival was 40%; for the patients receiving no radiotherapy, 2-year survival was 5%. Male sex, age, treatment, and clinical stage were prognostic for survival. Patients with a CCI score of 3 or more showed a better survival after surgery than after radiotherapy. Patients with a CCI score of 3 or more who were surgically treated had a higher prevalence of forced expiratory volume in 1 second of 70% or more compared with the patients receiving radiotherapy., Conclusions: Patients with a CCI score of 3 or more have an increased risk of major postoperative complications. Nevertheless, patients with a CCI score of 3 or more show a better survival after surgery than after radiotherapy. For patients with significant comorbidity but with sufficient pulmonary reserve, surgery offers the best outcome. For patients with a high CCI score and insufficient pulmonary reserve or for those who refuse surgery curative, radiotherapy is a good alternative.

Background: This study evaluates prognostic factors for survival in completely resected pathological stage IA nonsmall cell lung cancer with special emphasis on tumor size and assesses tumor recurrence rate by actual and actuarial analysis., Methods: From January 1989 to December 2001, 130 consecutive resections for pathological stage IA nonsmall cell lung cancer were performed. Pathological tumor size was categorized into 0 to 20 mm and 21 to 30 mm. Each patient was scaled according to the Charlson Comorbidity Index. The Kaplan-Meier method was used for estimation of actuarial recurrence rate and the cumulative incidence method was used to estimate the actual recurrence rate. Risk factors for overall and disease free survival were determined by univariate and multivariate Cox regression analysis., Results: Overall 5-year survival for patients with tumors 0 to 20 mm and 21 to 30 mm was 69% and 51%, respectively (p = 0.038). Disease-free survival at 5 years was 68% and 48%, respectively (p = 0.015). Only 27 patients had a recurrence and 69 patients died during follow-up. The actual 10-year recurrence rate was lower than the actuarial recurrence rate (23% vs 29%). Larger tumor size (relative risk 1.6; 95% confidence interval 1.0 to 2.7), Charlson Comorbidity Index score greater than or equal to 3 (relative risk 3.7; 95% confidence interval 1.7 to 8.0), and pneumonectomy (relative risk 2.1; 95% confidence interval 1.1 to 4.2) independently predicted adverse outcome., Conclusions: Tumor size affects survival in resected stage IA nonsmall cell lung cancer. Current definition of stage IA disease should be substaged into two separate stages. In patients with early-stage lung cancer and relatively good prognosis actual recurrence rate is more realistic than the actuarial recurrence rate.

Of 111 patients with non-small cell lung cancer without clinically evident N2 disease 95 underwent mediastinoscopy between 1975 and 1985. In 63 cases mediastinoscopy was positive and in 32 negative. The patients with a positive mediastinoscopy were considered to have inoperable disease. Their 3- and 5-year survival rates were 5% and 0%, respectively. The patients with a negative mediastinoscopy and 16 patients in whom no mediastinoscopy was performed because of a peripheral tumor underwent operation. They underwent complete tumor resection and mediastinal lymph node dissection. Unsuspected N2 disease was found. Their 3- and 5-year survival rates were 19% and 10%, respectively. The better survival rate in the operated group was statistically significant and mainly due to a better survival of the lobectomy group. Multiple regression analysis showed no favorable prognostic factors in the nonoperated group, but in the operated group lobectomy and central location of the tumor significantly improved the prognosis. We conclude that patients with unsuspected stage IIIa non-small cell lung cancer discovered at thoracotomy benefit from complete tumor resection and mediastinal lymph node dissection, especially if the resection can be confined to lobectomy and if the tumor is located centrally.