Prognosis of resected non-small cell lung cancer patients with intrapulmonary metastases.

BACKGROUND

In the current TNM staging system revised in 1997 for lung cancer, intrapulmonary metastases (PM) are classified into two categories: PM1 (in the same lobe of the primary tumor), designated as T4; and PM2 (in a different lobe), as M1. There have been no large-scale analyses on PM in non-small cell lung cancer (NSCLC) patients. We collected data nationwide in Japan for 7408 lung cancer patients undergoing surgical resection during a single year, 1994. We analyzed the long-term survival of NSCLC patients to evaluate the prognostic impact of PM in relation to other prognostic factors.

METHOD

Medical records of 6525 NSCLC patients undergoing surgical resection during a single year, 1994, were analyzed as a subset work of the Japanese Joint Committee of Lung Cancer Registry. The committee sent a questionnaire on outcome and clinicopathological profiles to 303 institutions.

RESULTS

There were 6080 PM0 (no PM), 317 PM1, and 128 PM2 patients. The 5-year survival rates were 55.1% for PM0 patients, 26.8% for PM1, and 22.5% for PM2 patients, respectively. The differences in survival between patients with PM0 and PM1 and between patients with PM0 and PM2 were significant (p < 0.001, respectively); the difference in survival was not significant between patients with PM1 and PM2 (p = 0.298). In R0 and N0 patients, survival differences were similar for PM0, PM1, and PM2 patients. Significant survival difference was detected between T3 and PM1 (p = 0.0317) and between PM1 patients and T4 patients excluding PM1 (p = 0.0083). The 5-year survival rates of PM2 patients and M1 patients excluding PM2 were 22.5% and 20.5%, respectively, and there was no significant difference between the groups (p = 0.434).

CONCLUSION

There was no significant survival difference between NSCLC patients with PM1 and PM2. The survival of patients with PM1 was between that of the T3 and T4 patients excluding PM1.