Survival and prognostic factors in 24 cases of surgically resected synchronous multiple primary non-small-cell lung cancer

Abstract

Objective The clinical/pathological staging and optimal therapeutic strategy for synchronous multiple primary non-small-cell lung cancer(SMP-NSCLC) remain unclear.In this study,the survival of SMP-NSCLC patients after surgical therapy and the factors affecting survival were analyzed.Methods 24 cases of SMP-NSCLC diagnosed according to Martini clinical criteria and underwent surgical therapies in China-Japan Friendship Hospital from November 2000 to July 2013 were analyzed retrospectively.Age,gender,position of tumors,surgical procedure,pT stage,pN stage and postoperative adjuvant therapy were analyzed as potential prognostic factors using univariate(log-rank test model) and multivariate analyses(Cox proportional hazards model).Results Pathological diagnosis for all of the 24 cases of SMP-NSCLC were confirmed postoperatively,unilateral in 16 and bilateral in 8 patients.The morbidity during hospital stay was 8.3％ (two patients),with no perioperative death.The overall 5-year survival rate was 43.1％,and the median survival time was 47 months.In the univariate analysis,advanced age (P =0.949),gender (P =0.089) and position of tumors (P =0.765) had no influence on survival.Pneumonectomy or multiple lobectomy was a poorer prognostic factor,compared with single lobectomy,lobectomy together with sublobar resection and multiple sublobar resection (P =0.023).Better survival was obtained from patients with both tumors classified as pT1 rather than at least one of the tumors classified as pT2 or even higher stage(P =0.000).N1 metastasis was also a poor prognostic factor(P =0.006).In the multivariate analysis,surgical procedure (P =0.010),pN stage (P =0.012) and postoperative adjuvant therapy(P =0.018) were identified as independent prognostic factors.Conclusion The survival of SMP-NSCLC patients after surgical therapy was satisfactory.Pulmonary function preservation may affect survival more rather than radical resection,also less pN stage and postoperative adjuvant therapy leaded to better survival.Worse survival obtained from higher pT stage might since pN stage updated. Key words: Carcinoma, none small cell lung ; Lung neoplasms ; Neoplasms, multiple primary ; Pulmonary surgical procedures ; survival analysis