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Vol.43 No.6 contents | Japanese/English |
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- Original Article -
Survival and Disease-free Interval in Patients After Curative Resection for Primary Lung Cancer With Intrapulmonary Metastasis
Ryoji Kawano1, Ryuta Fukai1, Toshiya Yokota1, Shingo Ikeda1, Enjo Hata11Surgical Department of Respiratory Center, Mitsui Memorial Hospital, Japan
Objective. To find out the optimal surgical treatment in primary lung cancer patients with intrapulmonary metastasis (pm), we evaluated the various clinicopathological factors of the patients who received complete surgical resection with a lymphadenectomy. Methods. Thirty-four patients with intrapulmonary metastasis were classified into 26 pm patients within the same lobe as the primary tumor (pm 1) and 8 patients within another lobe to that containing the primary tumor (pm 2). Results. The overall survival of pm patients was 44.4% at 5-years. The 5-year survival rate of pm 1 was 54.8%, but that of pm 2 was 0%. The 5-year disease-free survival (5-DFS) rate of all patients showed 28.9%. The 5-DFS of pm 1 was 33.3%, and the 2-DFS that of pm 2 was 14.3%. The analysis of outcome of the 5-year survival rate of pm 1 patients based on clinicopathological factors (tumor histology, number of pm, vessel invasion, T factor apart from pm factor, and N factor) showed that the nodal involvement is the most influential factor. The 5-year survival rate of the N-positive group (N1: 2 cases, N2: 9 cases, N3: 4 cases) was 38.9% and that of the N-negative group was 74.1%. A statistical significant difference between the two groups was identified (p=0.005). The 5-DFS of the N-negative group was 66.7%, and 3-DFS of N positive group was 3.7% (p=0.0002). Postoperative recurrence was identified in 17 (62.9%) of 27 pm 1 patients, and the most recurrence site was the lung. The recurrence rate based on the N factor was 4 (33.3%) of 12 patients without nodal involvement and 13 (86.6%) of 17 patients with nodal involvement. Conclusion. pm 1 patients without lymph node metastasis appeared to be the most appropriate candidates for the surgical procedure. Even if completely curative resection of pm 1 patients with lymph node metastasis seemed to have been achieved, there was a high rate of tumor recurrence. Therefore, surgical treatment of pm 1 patients with nodal involvement was suggested to be less effective for the local control of tumor.
key words: Primary lung cancer, Intrapulmonary metastasis, Lymph node metastasis, Operative indication, Tumor recurrence
Received: May 30, 2003
Accepted: June 23, 2003
JJLC 43 (6): 691-697, 2003
