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Non-Small Cell Lung Cancer: Prognostic Factors in Patients Treated with Surgery and Postoperative Radiation Therapy¹

¹ From the Department of Radiation Oncology (J.H.L., M.M., S.M.H., M.G.M., W.G.M.) and the Divisions of Thoracic Surgery (L.R.K., J.S.F.) and Hematology/Oncology (S.M.H.), University of Pennsylvania Medical Center, 3400 Spruce St, 2 Donner, Philadelphia, PA 19104. From the 1998 RSNA scientific assembly. Received November 30, 1998; revision requested January 14, 1999; revision received March 1; accepted July 1. Address reprint requests to M.M. (e-mail: machtay@xrt.upenn.edu).

PURPOSE: To determine survival outcomes, to identify adverse prognostic factors for relapse, and to compare American Joint Commission on Cancer (AJCC) staging systems in patients with non–small cell lung cancer (NSCLC) treated with surgery and postoperative radiation therapy.

MATERIALS AND METHODS: Between 1980 and 1995, 211 patients with NSCLC underwent surgery and postoperative radiation therapy. Surgery consisted of wedge resection (12.5%), lobectomy (67.8%), or pneumonectomy (19.7%). Pathologic stages (1992 AJCC) included I (n = 22), II (n = 70), IIIA (n = 104), and IIIB (n = 12). Indications for radiation therapy included compromised margins (n = 81) and/or positive mediastinal nodes (n = 55). Prognostic factors were identified by using univariate and multivariate models.

RESULTS: Overall 3-year survival for patients with stage I, II, and IIIA cancer was 58.9%, 44.1%, and 43.2%, respectively. Older age (P = .008), male sex (P = .021), large primary tumor (P = .004), and multiple positive mediastinal nodes (P = .046) were associated with worse rates of survival. Actuarial risk of local-regional relapse (36 patients) was 21.4% at 3 years. In a multivariate model, use of wedge resection (P = .001), positive margins (P = .010), and larger pathologic tumor (P = .059) were risk factors for local-regional recurrence. Actuarial rate of distant failure was 55.2% at 3 years.

CONCLUSION: Local-regional control can be achieved with surgery and radiation therapy in approximately 80% of patients; however, the rate of distant metastasis remains unacceptably high. Other variables, such as multiple positive nodes, may serve to identify patients at higher risk for relapse and poorer survival. Methods for improving treatment outcomes in these patients should be pursued.

Index terms: Lung neoplasms, 60.321 • Lung neoplasms, surgery, 60.321, 60.45 • Lung neoplasms, therapeutic radiology, 60.321, 60.1299

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