Abstract
Simple SummarySurgery is the mainstay treatment of non-small-cell lung cancer, but its impact on survival beyond 15 years has never been reported so far. We studied retrospectively clinical characteristics and short and long-term survival of a single-institution patient population whose baseline data were prospectively collected. All patients underwent major lung resection between June 2001 and December 2002. Vital status was obtained by checking INSEE database and verifying if reported as “non-death” by the hospital administrative database and direct phone interviews with patients of families. A total of 345 patients were analyzed; 15-year and 20-year overall survival rates were 12.2% and 5.7%, respectively. At univariate analysis, predictors of worse survivals were increasing age at surgery, lower BMI, weight loss, higher baseline C-reactive protein, pathological stage, and, among patients with adenocarcinoma, higher grade. Increasing age, cumulative smoking, lower BMI, and pathological stage were independent predictors of long-term survival at Cox multivariate analysis. We conclude that very-long-term survivals can be achieved after surgery of NSCLC, and factors classically predicting 5- and 10-years survival also determines longer outcomes suggesting that both initial tumor aggressiveness and host characteristics act beyond the period usually taken into account in oncology.Surgery is the mainstay treatment of non-small-cell lung cancer (NSCLC), but its impact on very-long-term survival (beyond 15 years) has never been evaluated. Methods: All patients operated on for major lung resection (Jun. 2001–Dec. 2002) for NSCL in the Thoracic Surgery Department at Paris-Hôtel-Dieu-University-Hospital were included. Patients‘ characteristics were prospectively collected. Vital status was obtained by checking INSEE database and verifying if reported as “non-death” by the hospital administrative database and direct phone interviews with patients of families. Results: 345 patients were included. The 15- and 20-year survival rates were 12.2% and 5.7%, respectively. At univariate analysis, predictors of worse survivals were: increasing age at surgery (p = 0.0042), lower BMI (p = 0.009), weight loss (p = 0.0034), higher CRP (p = 0.049), pathological stage (p = 0.00000042), and, among patients with adenocarcinoma, higher grade (p = 0.028). Increasing age (p = 0.004), cumulative smoking (p = 0.045), lower BMI (0.046) and pathological stage (p = 0.0026), were independent predictors of long-term survival at Cox multivariate analysis. In another model, increasing age (p = 0.013), lower BMI (p = 0.02), chronic bronchitis (p = 0.03), lower FEV1% (p = 0.00019), higher GOLD class of COPD (p = 0.0079), and pathological stage (p = 0.000024), were identified as independent risk factors. Conclusions: Very-long-term survivals could be achieved after surgery of NSCLC, and factors classically predicting 5- and 10-years survival also determined longer outcomes suggesting that both initial tumor aggressiveness and host’s characteristics act beyond the period usually taken into account in oncology.
Highlights
Lung cancer is the leading cause of cancer death worldwide [1,2,3,4]
With respect to chronic bronchitis/chronic obstructive pulmonary disease (COPD), we previously reported that chronic bronchitis was an independent predictive factor for 5-year survival [32,35]
We have shown in an earlier study that COPD and chronic bronchitis reduce the number of mature dendritic cells in the tumor microenvironment of non-small-cell lung cancer (NSCLC) [32,35], whereas an increased number of these antigen-presenting cells in the tumor microenvironment has been shown to be associated with better survival [6,21,32]
Summary
Lung cancer is the leading cause of cancer death worldwide [1,2,3,4]. With respect to treatment, surgical resection is generally proposed at the less advanced stages of the malignancy and has been shown to contribute mainly to improved survival rates up to 5 years (after treatment), especially if a multimodal approach is used [5]. With regard to long-term outcomes after surgical resection, studies on 10-year survival rates have only been made by single institutions [6,7], and only two institutional studies involving small samples have investigated longer-term survivals, of 13 and 14 years, respectively [8,9]. In these studies, factors associated with longer survival were younger age, female sex, lower tumor stage, and lobar resection (versus pneumonectomy) [9]. Another study, which included smoking habits, identified the following independent risk factors for 7-year survival: lower pathological stage, smoking cessation before surgery, lower age, adenocarcinoma histology, and lobar resection; sex of patient was not a factor [10]
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