• Ann. Thorac. Surg. · Jun 2004

    Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung carcinoma.

    • Toshihiko Iizasa, Makoto Suzuki, Kazuhiro Yasufuku, Akira Iyoda, Mizuto Otsuji, Shigetoshi Yoshida, Yasuo Sekine, Kiyoshi Shibuya, Yukio Saitoh, Kenzo Hiroshima, and Takehiko Fujisawa.
    • Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
    • Ann. Thorac. Surg. 2004 Jun 1;77(6):1896-902; discussion 1902-3.

    BackgroundThe aim of this study was to clarify preoperative lung function as a prognostic factor for the long-term survival of, and to discuss the appropriateness of lobectomy for, patients with stage I non-small cell lung carcinoma who have poor preoperative pulmonary function.MethodsThe study group consisted of 402 lobectomized patients with stage I non-small cell lung carcinoma treated by complete resection from 1985 to 1997. Preoperative percent forced vital capacity [(forced vital capacity/predicted forced vital capacity) x 100], FEV(1)% [(forced expiratory volume in 1 second/forced vital capacity) x 100], arterial carbon dioxide tension, and smoking were statistically analyzed as prognostic factors together with other host and tumor biologic factors.ResultsMultivariate analysis demonstrated that tumor size (p < 0.0001) was the most significant prognostic factor for survival from primary lung cancer. Age (p < 0.0001), sex (p = 0.0036), and FEV(1)% (p = 0.0046) were found to be independent prognostic factors for survival from death by nonprimary lung cancer-related causes. Smoking was highly correlated with FEV(1)% (correlation coefficient = -0.511; p < 0.0001). The 100 patients with a preoperative FEV(1)% less than 70% included 34 patients with nonprimary lung cancer-related deaths, whereas the 302 patients with an FEV(1)% of 70% or greater included only 23 patients (p < 0.0001).ConclusionsAlong with tumor size, FEV(1)% is the most significant prognostic factor for patients with stage I non-small cell lung carcinoma with regard to survival from death by other causes. Lobectomy may not be preferred as an appropriate surgical modality for patients with stage I non-small cell lung carcinoma with small peripheral nodules who exhibit poor pulmonary function, especially lowered FEV(1)%.

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