Abstract
Many factors have been individually related to outcome in populations of non-small-cell lung cancer (NSCLC) patients. Factors responsible for the outcome of an individual after surgical resection are poorly understood. We have examined the importance of 'tumour volume' in determining prognosis of patients following resection of NSCLC in a multivariate model. Cox's proportional hazard analysis was used to determine the relative prognostic significance of stage, patient age, gender, tumour cell-type, nodal score and estimated 'tumour volume' in 669 cases with NSCLC treated with surgical resection, of which 280 had died. All factors (except tumour cell-type, P = 0.33) were individually related to survival (P < 0.05). When examined together, survival time was significantly and independently related to 'tumour volume' and stage (P < 0.001), and other factors ceased to be significant. In cases with stage I or II tumours, risk of death was found to increase significantly with increasing estimated 'tumour volume' (23.8% relative increase in hazard to death per doubling of 'tumour volume', 95% confidence interval 13.2-35.2%, P < 0.001 stage I; P < 0.006 stage II). In cases with stage IIIa tumours this factor alone was the significant prognostic variable. In conclusion, an estimate of 'tumour volume' significantly improves prediction of prognosis for individual NSCLC patients with UICC stage I or II tumours.
Highlights
We have previously shown that an estimate of non-small-cell lung cancer (NSCLC) 'tumour volume' has a complex relationship with age which is dependent on patient gender and histological cell type (Pendleton et al, 1996)
In this study we examine the importance of 'tumour volume' as a predictor of survival after resection of NSCLC in a multivariate model including stage, patient age, gender, histopathological tumour cell type and nodal score
The distribution of the number of cases and 'tumour volume' by clinicopathological variable groups is summarised in Table
Summary
The patient group comprised 669 cases with NSCLC treated by surgical resection between 1987 and 1992 at the Regional Thoracic Surgical Unit for Mersey region, UK. Patients were accepted solely on the basis of operability; age did not contribute to the assessment or selection process. All resections underwent thoracic nodal sampling at surgery. Resected specimens were received in the department of histopathology at Broadgreen Hospital, Liverpool, UK, inflation-fixed in buffered formalin. The specimens were examined macroscopically by a histopathologist whose examination included measurement of the maximum tumour diameter in three dimensions using a Vernier calliper. 'Tumour volume' was estimated by multiplying the three maximum dimensional measurements. Material from the specimens was taken from representative areas for subsequent light microscopic examination by two histopathologists within the department acting independently
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