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DOES MICROSCOPIC INVOLVEMENT OF RESECTION MARGINS AFFECT LONG-TERM SURVIVAL AFTER RESECTION OF STAGE I AND II LUNG CANCER?

Thoracic Surgery. Nottingham City Hospital, Nottingham, United Kingdom

PURPOSE: To determine whether other pathological variables such as the degree of differentiation of the cancer cells and the presence of tumour cells on the resection margins on microscopy (R1 resection) did alter survival following resection for non-small-cell lung cancer (NSCLC).

METHODS: The clinical and pathological records of the 857 consecutive patients [586 male and 271 female, median age 66 (range 35 to 84) years] who underwent lobectomy/bilobectomy (n=558) or pneumonectomy (n=299) for Stage I (n=516) or II (n=341) NSCLC in our unit from 1991 to 2005 were reviewed. Survival was calculated according to the Kaplan-Meier method. The impact of multiple variables on survival was evaluated with univariate and multivariate tests.

RESULTS: Operative mortality was 4.1 % (35 cases) [2% (n=11) after lobectomy and 8% (n=24) after pneumonectomy]. In 47 cases (5.5%) the pathological report did not confirm excision to be complete microscopically (R0) due to: microscopic involvement of the bronchial margin in 34 cases, of the vascular margin in 8 cases and other resection margins in 5 cases. In addition, in a further 65 cases (8%) the shortest clear distance to the margin was less than 5 mm. Overall median survival was 59 months. The 5- and 10-year survivals were 55% and 36% for Stage I, and 41% and 22% for Stage II respectively. On univariate analysis staging, and degree of differentiation were predictors for long-term survival. R1 resection did approach significance (p=0.055), but not tumour being less than 5 mm from the clear margins (p=0.9).On multivariate analysis tumour staging was the only pathological variable affecting survival (Table 1).

CONCLUSION: Tumour stage is the pathological determinant for survival after anatomical resection of Stage I/II non-small-cell lung cancer. It does outweigh tumour cell differentiation, microscopic involvement of resection margins and close distance to clear resection margins as a predictor of long-term survival in these patients.

CLINICAL IMPLICATIONS: Demographic variables and tumour staging determine survival following surgery for lung cancer. Other pathological variables do not signifficantly alter outcomes.
Table 1— Independent Predictors of Survival

Variables Hazard ratio (95% CI) p Gender 1.32 (1.04 to 1.66) 0.017 Age>75 1.42 (1.03 to 1.95) 0.028 Low BMI 1.72 (1.12 to 2.64) 0.012 Tumour Stage 2.49 (1.49 to 4.18) 0.005

DISCLOSURE: Sherilyn Tay, None.