Survival in Males with Bronchogenic Carcinomas Resected as Asymptomatic Solitary Pulmonary Nodules

Abstract

hen the diagnosis of lung cancer follows the development of symptoms, a large portion of patients already have inopW erable disease and many who may still have resectable pulmonary lesions have metastatic disease. The diagnosis of lung cancer by x-ray examination before the disease has progressed to the point of producing symptoms is an obvious approach in attempting to increase the operability rate and decrease the proportion of lung cancers which spread beyond the lung. The study reported here was designed to examine the value of this approach. A large-scale cooperative study was initiated in 1959 in a number of Veterans Administration and Armed Forces hospitals for the study of resected asymptomatic solitary pulmonary nodules 6 cm. or less in diameter in males, the nature of these nodules having been undiagnosed preoperatively. Cases were collected largely through routine chest films taken on admission to hospitals for diseases other than pulmonary or for pulmonary diseases unrelated to the nodule. The collection of cases of pulmonary nodules of various etiologies was discontinued in the spring of 1962, but patients with nodules which proved malignant were added to the study up to October 31, 1963. The first phase of the study has been reported previously [8, 91. The present report is concerned with 392 males with primary bronchogenic carcinomas appearing as asymptomatic solitary pulmonary nodules 6 cm. or less in diameter first diagnosed at thoracotomy.t Of the total of 392 patients, 22, or 5.6%, had unresectable lesions, giving a total resectability rate of 94.4%. The cancer was confined to the lung in 308 (78.6%); in 62 (15.8%) there was gross or microscopic evidence that not all tumor had been resected. The operative mortality