Surgical Resutls of Stage IV Non-Small Cell Lung Cancer ( NSCLC )

Maeng, Dae Hyun; Chung, Kyung Young; Kim, Kil Dong; Kim, Do Gyun

Abstract

BACKGROUND: The surgical indications of stage IV non-small cell lung cancer(NSCLC) are extremely limited with its controversial results. We analyzed the surgical results and survival in selected patients with resectable stage IV NSCLC. MATERIAL AND METHOD: We reviewed the medical records of 21 patients who underwent operation for stage IV NSCLC from Jan. 1992 to Sep. 1999. RESULT: The mean age of patients was 55.6 years(range: 35 to 78). Sixteen were men and 5 were women. Tissue types were squamous cell carcinoma in 10(45.5%), adenocarcinoma in 9(40.9%), large cell carcinoma in 1 and carcinosarcoma in 1. Distant metastatic lesions were ipsilateral other lobe of lung in 18, brain in 2 and adrenal gland in 1. Pneumonectomy was performed in 16 patients, bilobectomy in 3, and lobectomy in 2 who underwent previous operatin for brain metastasis. Mean follow-up duration was 21.2+/-17.7 months. During follow-up period, 13 patients died. Three-and 5-year survival of patients were 38.0% and 19.0%, the median survival time was 19.1+/-7.8 months. In the group with ipsilateral pulonary metastasis(PM, n=18), 3- and 5-year survival of patients with N0 and N1(n=9) disease were 64.8% and 32.4%, median survival time was 55.3+/-27.2 months. Three-year survival of patients with N2(n=9) disease was 11.1%, median survival time was 10.6+/-0.3 months. The survival of N0 and N1 disease group was significantly better than that of N2 disease group(p=0.042). Also the disease free survival of N0 and N1 was significantly better than that of N2 disease in overall group(53.3 months vs 12.1 months, p=0.036) and ipsilateral PM group(63.4 months vs 8.8 months, p=0.001).
CONCLUSIONS
We suggest that surgical treatment is worthful modality in well selected patients with stage IV NHSCLC especially with ipsilateral PM and N0 or N1 disease. Nevertheless our study indicate questions that will need to be experienced further in larger studies.