Survival In Early-stage Lung Cancer Research Articles

Racial and Ethnic Disparities in Early-Stage Lung Cancer Survival

Black patients with lung cancer diagnosed at early stages-for which surgical resection offers a potential cure-experience worse overall survival than do their white counterparts. We undertook a population-based study to estimate the racial and ethnic disparity in death from competing causes and assessed its contribution to the gap in overall survival among patients with early-stage lung cancer. We collected survival time data for 105,121 Hispanic, non-Hispanic Asian, non-Hispanic black, and non-Hispanic white patients with early-stage (IA, IB, IIA, and IIB) lung cancer diagnosed between 2004 and 2013 from the Surveillance, Epidemiology, and End-Results registries. We modeled survival time using competing risk regression and included as covariates sex, age at diagnosis, race/ethnicity, stage at diagnosis, histologic type, type of surgical resection, and radiation sequence. Adjusting for demographic, clinical, and treatment characteristics, non-Hispanic blacks experienced worse overall survival compared with non-Hispanic whites (adjusted hazard ratio [aHR], 1.05; 95%CI, 1.02-1.08), whereas Hispanics and non-Hispanic Asians experienced better overall survival (aHR, 0.93; 95%CI, 0.89-0.98; and aHR, 0.82; 95%CI, 0.79-0.86, respectively). Worse survival from competing causes of death, such as cardiovascular disease and other cancers-rather than from lung cancer itself-led to the disparity in overall survival among non-Hispanic blacks (adjusted relative risk, 1.07; 95%CI, 1.02-1.12). Narrowing racial and ethnic disparities in survival among patients with early-stage lung cancer will rely on more than just equalizing access to surgical resection and will need to include better management and treatment of smoking-related comorbidities and diseases.

Baseline C-Reactive Protein Level Predicts Survival of Early-Stage Lung Cancer: Evidence from a Systematic Review and Meta-Analysis

The prognostic impact of baseline C-reactive protein (CRP) in non-small-cell lung cancer (NSCLC) is debated. To evaluate this issue, we performed a systematic review and meta-analysis to explore the role of CRP value in predicting early-stage NSCLC survival. Ten articles on early-stage NSCLC were eligible and included in our study. We performed a random-effects meta-analysis and assessed heterogeneity and publication bias. We pooled hazard ratio (HR) estimates and their 95% confidence intervals (CIs) on mortality for the comparison between the study-specific highest category of CRP level versus the lowest one. In overall analysis, elevated pretreatment CRP values were significantly associated with poor overall survival (HR 1.60, 95% CI 1.30-1.97, p<0.001, I2 = 71.9%). Similar results were observed across considered strata. However, higher mortality risk was reported in studies in which CRP was combined with other factors (HR 1.96, 95% CI 1.58-2.45) and in those using a cutoff value of 3 mg/L (HR 1.89, 95% CI 1.52-2.35). Based on our analysis, baseline high CRP level is significantly associated with poor prognosis in early-stage NSCLC. Further prospective controlled studies are needed to confirm these data.

A week in the life of lung cancer survivors: Daily reports of stress, worry, mood, and symptoms.

This study examined the day-to-day lives of early stage lung cancer survivors who were discharged from treatment between 2 and 24 months prior to the study. Lung cancer survivors were called on eight consecutive nights and completed an interview about their daily experiences. Repeated measures, multilevel analysis of the phone interview data was conducted. Survivors reported few daily stressor exposures or somatic symptoms. Daily moods were generally positive, and survivors reported living quite independently. Lung cancer survivors did not report experiencing health-related worry on a daily basis. The findings from this study create a much more positive picture of lung cancer survivorship relative to prior studies.

Surgery in high-volume hospitals not commission on cancer accreditation leads to increased cancer-specific survival for early-stage lung cancer

BackgroundQuality of oncologic outcomes is of paramount importance in the care of patients with non–small cell lung cancer (NSCLC). We sought to evaluate the relationship of hospital volume for lobectomy on cancer-specific survival in NSCLC patients treated in California, as well as the influence of Commission on Cancer (CoC) accreditation. MethodsThe California Cancer Registry was queried from 2004 to 2011 for cases of Stage I NSCLC and 8,345 patients were identified. Statistical analysis was used to determine prognostic factors for cancer-specific survival. ResultsA total of 7,587 patients were treated surgically. CoC accreditation was not significant for cancer-specific survival, but treatment in high-volume centers was associated with longer survival when compared with low- and medium-volume centers (hazard ratio 1.77, 1.474 to 2.141 and hazard ratio 1.23, 1.058 to 1.438). ConclusionThese data suggest that surgical treatment in high-volume hospitals is associated with longer cancer-specific survival for early-stage NSCLC, but that CoC accreditation is not.

Patient-provider discussion of physical activity among early stage lung cancer survivors.

Lung cancer accounts for approximately 14% of all new cancer cases and 28% of cancer deaths in the United States each year [1], with 52% of those diagnosed with localized disease now expected to live beyond five-years [1]. Lung cancer survivors can experience significant ongoing symptom burden, including impairments in quality of life and high rates of dyspnea and fatigue. Evidence suggests that physical activity can enhance cardiorespiratory fitness, improve quality of life and reduce symptom burden [2]; however the majority of cancer survivors do not engage in sufficient physical activity to meet national guidelines (≥150 minutes per week of moderate intensity exercise)[3]. Participation in physical activity may be particularly crucial for lung cancer survivors who tend to be older, often have a history of smoking, and commonly suffer from comorbid conditions such as chronic obstructive pulmonary disease. Cancer survivors remain at increased risk of cardiovascular disease, secondary cancers and diabetes [4]. The importance of health promotion has become increasingly recognized, with the role of providers in encouraging participation in physical activity noted, along with a recommendation to include physical activity in survivorship care plans [5, 6]. The majority of Americans identify their physician as their primary source of advice concerning health information [7] and The American College of Preventive Medicine recommends physical activity counseling as part of all routine patient visits. Importantly, the discussion of physical activity with an oncologist has been associated with greater patient participation in physical activity [8]; however exercise may not be discussed as frequently as needed. A nationwide survey found that few survivors received recommendations regarding physical activity, diet and smoking guidelines, and that survivors were less likely than those without a history of cancer to receive a physical activity recommendation [9]. The goals of the current study were to (1) describe early-stage lung cancer survivors’ self-reported discussion of physical activity with health-care providers, and (2) examine the association between sociodemographic, disease and health behavior variables and discussion characteristics.

Physical activity preferences of early-stage lung cancer survivors

Engagement in physical activity can provide important benefits for cancer patients and survivors, including those diagnosed with lung cancer. Despite this, many survivors do not engage in recommended levels of physical activity and little is known about the obstacles encountered by lung cancer survivors. The current study examines the physical activity preferences of early-stage lung cancer survivors. As part of a larger survey study, 175 non-small cell lung cancer survivors who were on average 3.6years from surgical treatment responded to questions regarding their preferences for physical activity and physical activity advice. Demographic and medical characteristics were also collected. The majority of respondents (62%) reported a desire to receive advice regarding physical activity, predominantly before treatment (68%), in face-to-face interactions (95%) with a physician (80%), and within the context of a cancer care center (92%). Approximately half of participants indicated they would be interested in an exercise program tailored to lung cancer survivors and most individuals (73%) reported feeling capable of engaging in an exercise program. Differences in physical activity preferences emerged based on demographic and disease characteristics. The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity. Important differences were found based on demographic and medical characteristics, which may warrant consideration in the development and dissemination of physical activity interventions for this cancer survivor population.

Circulating levels of immune and inflammatory markers and long versus short survival in early-stage lung cancer

BackgroundSome patients diagnosed with early-stage lung cancer and treated according to standard care survive for only a short period of time, while others survive for years for reasons that are not well understood. Associations between markers of inflammation and survival from lung cancer have been observed. Materials and methodsHere, we investigate whether circulating levels of 77 inflammatory markers are associated with long versus short survival in stage I and II lung cancer. Patients who had survived either <79 weeks (∼1.5 years) (short survivors, SS) or >156 weeks (3 years) (long survivors, LS) were selected from a retrospective population-based study. Logistic regression was used to calculate adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The false discovery rate was calculated to adjust for multiple testing. ResultsA total of 157 LS and 84 SS were included in this analysis. Thirteen markers had adjusted OR on the order of 2- to 5-fold when comparing the upper and lower quartiles with regard to the odds of short survival versus long. Chemokine CCL15 [chemokine (C-C motif) ligand 15] was the most significant marker associated with increased odds of short survival (ORs = 4.93; 95% CI 1.90–12.8; q-value: 0.042). Smoking and chronic obstructive pulmonary disease were not associated with marker levels. ConclusionsOur results provide some evidence that deregulation of inflammatory responses may play a role in the survival of early-stage lung cancer. These findings will require confirmation in future studies.

A Functional Variant at 19q13.3, rs967591G&amp;gt;A, Is Associated with Shorter Survival of Early-Stage Lung Cancer

This study was conducted to investigate the associations between single-nucleotide polymorphisms (SNP) in 19q13.3 and survival of patients with early-stage non-small cell lung cancer (NSCLC), and to define the causative functional SNP of the association. A two-stage study design was used to evaluate five SNPs in relation to survival outcomes in 328 patients and then to validate the results in an independent patient population (n = 483). Luciferase assay and real-time PCR were conducted to examine functional relevance of a potentially functional SNP. Of the five SNPs, three SNPs (rs105165C>T, rs967591G>A, and rs735482A>C) were significantly associated with survival outcomes in a stage I study. The rs967591A allele had significantly higher activity of the CD3EAP promoter compared with the rs967591G allele (P = 0.002), but the SNP did not have an effect on the activity of PPP1R13L promoter. The rs967591G>A was associated with the level of CD3EAP mRNA expression in lung tissues (P = 0.01). The rs967591G>A exhibited consistent associations in a stage II study. In combined analysis, the rs967591 AA genotype exhibited a worse overall survival (adjusted HR = 1.69; 95% confidence interval = 1.29-2.20; P = 0.0001). The rs967591G>A affects CD3EAP expression and thus influences survival in early-stage NSCLC. The analysis of the rs967591G>A polymorphism can help identify patients at high risk of a poor disease outcome.

Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance

At present, there is no consensus on the optimal strategy for follow-up care after curative resection for lung cancer. We sought to understand the patterns of recurrence and second primary lung cancer, and their mode of detection, after resection for early-stage non-small cell lung cancer in patients who were followed by routine surveillance computed tomography scan. We reviewed the outcomes of consecutive patients who underwent resection for early-stage non-small cell lung cancer at Memorial Sloan-Kettering Cancer Center between 2004 and 2009. A total of 1294 consecutive patients with early-stage non-small cell lung cancer underwent resection. The median length of follow-up was 35 months. Recurrence was diagnosed in 257 patients (20%), and second primary lung cancer was diagnosed in 91 patients (7%). The majority of new primary cancers (85 [93%]) were identified by scheduled routine computed tomography scan, as were a smaller majority of recurrences (157 [61%]). During the first 4 years after surgery, the risk of recurrence ranged from 6% to 10% per person-year but decreased thereafter to 2%. Conversely, the risk of second primary lung cancer ranged from 3% to 6% per person-year and did not diminish over time. Additional testing after false-positive surveillance computed tomography scan results was performed for 329 patients (25%), but only 4 of these patients (0.3%) experienced complications as a result of subsequent invasive diagnostic procedures. Almost all second primary cancers and the majority of recurrences were detected by post-therapeutic surveillance computed tomography scan. The risk of recurrence for early-stage non-small cell lung cancer survivors persisted during the first 4 years after resection, and vigilance in surveillance should be maintained.

Adjuvant Chemotherapy and Age-Related Biases in Non–Small Cell Lung Cancer

Five-year survival for early-stage lung cancer despite complete surgical resection is approximately 50%. Adjuvant chemotherapy has been shown to improve survival in some patients. Older cancer patients do not always receive standard therapy. The purpose of this study was to determine if there were age-related biases concerning the use of adjuvant chemotherapy after lobectomy for elderly patients with non-small cell lung cancer (NSCLC). A prospective lung cancer outcomes database was queried for all patients undergoing lobectomy for NSCLC pathologic stage IB and higher between April 2006 and October 2010. Patients who received neoadjuvant treatment or who died within 30 days of operation were excluded. Ninety-nine patients met the inclusion criteria. Patients were divided into 2 groups based on age (<70 or ≥70 years). The use of adjuvant chemotherapy was compared between groups. Sixty-nine patients (70%) were younger than 70 years and 30 (30%) were 70 years or older. There was a significant difference in the use of adjuvant chemotherapy between the 2 groups, with 46 (66.7%) of the younger patients and 7 (25%) of the elderly patients receiving adjuvant treatment (p<0.01). The difference persisted when analyzed by stage, with older patients less likely to receive chemotherapy among all patients with stage IB disease, stage II or more advanced disease, and stage IB lesions greater than or equal to 4 cm plus stage II or more advanced disease. In multivariate analysis of preoperative and postoperative factors, age remained the only independent predictor of chemotherapy use. Patients undergoing lobectomy who were 70 years of age or older received adjuvant chemotherapy less often than did younger patients.

Abstract 4149: Pathway-based serum microRNA profiling and late-stage non-small cell lung cancer survival

Abstract Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer mortality in the world. Nearly half of NSCLC patients are diagnosed with late-stage (stage III or stage IV) disease with an overall 5-year survival rate of less than 15%. Deregulation of microRNAs (miRNAs) is involved in cancer development, progression, and prognosis. Circulating miRNAs have been suggested as promising biomarkers for early detection, diagnosis, and prognosis of cancer. This ongoing study is to utilize a pathway-based approach to screen and validate serum miRNA profiles as predictors of survival using a large patient cohort of 348 late-stage NSCLC patients. In the testing set, pre-treatment serum miRNA profiles of four good- (survival time &amp;gt; 24 months) and four poor-survival (survival time &amp;lt; 6 months) patients were compared by Taqman miRNA microarray. 145 highly expressed serum miRNAs were identified from initial screening and 37 of them were mapped onto the 3′UTRs of a panel of 23 genes in TGF-β signaling pathway using computer-assisted miRNA target prediction program. All 37 miRNA candidates were subject to large-scale single-probe quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). The expression level of serum miR-30d, which targets TGFBR2 and was a previously reported serum marker for early-stage lung cancer survival, was significantly higher in the poor-survival group than the good-survival group (P = 0.0208) in our study population of late-stage lung cancer. The level of serum miR-93-3p that targets SMAD7 was significantly higher in the poor-survival group than the good-survival group (P = 9x10−6). The 2-year overall survival rate in patients with high serum miR-93-3p expression was significantly lower than that in those with low expression with an adjusted HR of 1.59 (95% CI, 1.24 - 2.03) (P = 2x10−4). In contrast, serum level of let-7g, that targets SMAD2, TGFBR1 and the activin A receptor family was significantly lower in the poor-survival group than in the good-survival group (P = 7x10−4), and patients with high serum let-7g expression was associated with a significantly better two-year survival (HR=0.48, 95% CI, 0.37 - 0.62, P = 1x10−8). Our results suggest that serum miR-30d, miR-93-3p and let-7g may become valuable biomarkers for survival in late-stage NSCLC patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4149. doi:1538-7445.AM2012-4149

Predictors and Outcomes of Limited Resection for Early-Stage Non-Small Cell Lung Cancer

Lobectomy is considered the standard treatment for early-stage non-small cell lung cancer (NSCLC); however, more limited resections are commonly performed. We examined patient and surgeon factors associated with limited resection and compared postoperative and long-term outcomes between sublobar and lobar resections. A population- and health system-based sample of patients newly diagnosed with stage I or II NSCLC between 2003 and 2005 in five geographically defined regions, five integrated health-care delivery systems, and 15 Veterans Affairs hospitals was observed for a median of 55 months, through May 31, 2010. Predictors of limited resection and postoperative outcomes were compared using unadjusted and propensity score-weighted analyses. All P values are from two-sided tests. One hundred fifty-five (23%) patients underwent limited resection and 524 (77%) underwent lobectomy. In adjusted analyses of patient-specific factors, smaller tumor size (P = .004), coverage by Medicare or Medicaid, no insurance or unknown insurance (P = .02), more severe lung disease (P < .001), and a history of stroke (P = .049) were associated with receipt of limited resection. In adjusted analyses of surgeon characteristics, thoracic surgery specialty (P = .02), non-fee-for-service compensation (P = .008), and National Cancer Institute cancer center designation (P = .006) were associated with higher odds of limited resection. Unadjusted 30-day mortality was higher with limited resection than with lobectomy (7.1% vs 1.9%, difference = 5.2%, 95% confidence interval [CI] = 1.5% to 10.8%, P = .003), and the adjusted difference was not statistically significant (6.5% vs 2.9%, difference = 3.6%, 95% CI = -.1% to 9.2%, P = .09). Postoperative complications did not differ by type of surgery (all P > .05). Over the course of the study, a non-statistically significant trend toward improved long-term survival was evident for lobectomy, compared with limited resection, in adjusted analyses (hazard ratio of death = 1.35 for limited resection, 95% CI = 0.99 to 1.84, P = .05). Evidence is statistically inconclusive but suggestive that lobectomy, compared with limited resection, is associated with increased long-term survival for early-stage lung cancer. Clinical, socioeconomic, and surgeon factors appear to be associated with the choice of surgical resection.

Video-Assisted Thoracic Surgery Lobectomy: Single Institutional Experience With 704 Cases

During the past decade, video-assisted thoracic surgery (VATS) lobectomy has been performed with increasing frequency in patients with early-stage non-small cell lung cancer (NSCLC). However, questions remain as to whether VATS lobectomy reduces local recurrence and improves long-term survival in patients with NSCLC. We retrospectively reviewed short-term and midterm outcomes, including postoperative morbidity, mortality, recurrence rate, and survival, in patients undergoing VATS lobectomy. Between 2003 and 2008, 704 patients underwent VATS lobectomy for the following indications: NSCLC (n = 548), carcinoid tumors (n = 7), pulmonary metastases (n = 22), and benign diseases (n = 127). One hundred eleven of 548 clinical stage I NSCLC patients (20.3%) experienced pathologic upstaging postoperatively. There were 9 in-hospital deaths (1.3%); all of these patients died of acute respiratory distress syndrome. Sixty-four patients experienced postoperative complications (9.1%). The median follow-up was 20 months for patients with NSCLC. During follow-up, 54 patients had a recurrence, and 13 patients died. Disease-free survival for patients with pathologic stage I disease was 92.7% at 1 year and 87.6% at 3 years. For patients with pathologic N1 (n = 55) and N2 diseases (n = 41), disease-free survival at 3 years was 79.3% and 57.1%, respectively. Video-assisted thoracoscopic surgery lobectomy is a technically feasible and safe operation with excellent survival for early-stage lung cancer. For patients with pathologic N1 or N2 diseases after VATS lobectomy, survival was not compromised by this minimally invasive approach.

Health-related quality of life among early-stage, non-small cell, lung cancer survivors

Background Limited data are available about the physical and mental functioning of individuals diagnosed and treated for early-stage lung cancer. To develop post-treatment guidelines and targeted resources for the growing number of lung cancer survivors, clinically relevant information about longer term health-related quality of life (HQOL) is needed. The current study examines lung cancer survivors’ HQOL and identifies associations between HQOL and demographic, disease and medical risk factors. Methods A total of 359 individuals diagnosed and surgically treated for stage IA or IB non-small cell lung cancer completed a post-treatment survey via mail or telephone that included the SF-36v2 as well as questions regarding demographic and medical factors. To better understand the impact of lung cancer treatment, we examined age- and gender-adjusted differences in HQOL as compared to a demographically matched sample of older adults, most with a significant smoking history, who participated in a lung cancer screening trial. Risk factors for impairments in HQOL were also identified. Results Compared to the screening sample, lung cancer survivors reported lower physical health scores, but did not differ in terms of mental health status. Dyspnea and distressed mood were most associated with HQOL impairments. Conclusions Early-stage lung cancer survivors are likely to experience mild impairment in physical functioning. They may benefit from management of distressed mood and referral to physical activity and pulmonary rehabilitation programs to promote HQOL outcomes.

Gene expression–based survival prediction in lung adenocarcinoma: a multi-site, blinded validation study

Although prognostic gene expression signatures for survival in early-stage lung cancer have been proposed, for clinical application, it is critical to establish their performance across different subject populations and in different laboratories. Here we report a large, training-testing, multi-site, blinded validation study to characterize the performance of several prognostic models based on gene expression for 442 lung adenocarcinomas. The hypotheses proposed examined whether microarray measurements of gene expression either alone or combined with basic clinical covariates (stage, age, sex) could be used to predict overall survival in lung cancer subjects. Several models examined produced risk scores that substantially correlated with actual subject outcome. Most methods performed better with clinical data, supporting the combined use of clinical and molecular information when building prognostic models for early-stage lung cancer. This study also provides the largest available set of microarray data with extensive pathological and clinical annotation for lung adenocarcinomas.

VEGF Polymorphisms and Survival in Early-Stage Non–Small-Cell Lung Cancer

Polymorphisms in the VEGF gene have been identified that are believed to have functional activity. We hypothesized that such polymorphisms may affect survival outcomes among early-stage non-small-cell lung cancer (NSCLC) patients. We evaluated the relationship between VEGF polymorphisms and overall survival (OS) among patients with early-stage NSCLC treated with surgical resection at Massachusetts General Hospital from 1992 to 2001. We specifically investigated the VEGF polymorphisms +936C>T (rs3025039), -460T>C (rs833061), and +405G>C (rs2010963). Analyses of genotype associations with survival outcomes were performed using Cox proportional hazards models, Kaplan-Meier methods, and the log-rank test. There were 462 patients and 237 deaths. Patients carrying the variant C allele of the VEGF +405G>C polymorphism had significantly improved survival (crude hazard ratio [HR] = 0.70; 95% CI, 0.54 to 0.90; P = .006; adjusted HR = 0.70; 95% CI, 0.54 to 0.91; P = .008). Five-year OS for patients carrying the variant C allele of the VEGF +405G>C polymorphism was 61% (95% CI, 54% to 67%) versus 51% (95% CI, 43% to 59%) for those who had the wild-type variant. There was a trend toward improved survival among patients carrying the variant T allele of the VEGF +936C>T polymorphism (crude HR = 0.74; 95% CI, 0.53 to 1.03; P = .07; adjusted HR = 0.73; 95% CI, 0.52 to 1.03; P = .07). Moreover, patients with higher number of variant alleles of the +405G>C and +936C>T polymorphisms had better survival. There was no association found with the -460T>C polymorphism. Polymorphisms in VEGF may affect survival in early-stage lung cancer.

Survival after resection for lung cancer is the outcome that matters

Background Lung cancer is the leading cause of cancer mortality in the United States. Stage-specific survival is well documented in national data sets; however, there remains limited recording of longitudinal survival in individual centers. Methods The VistA Surgery Package was employed to list operations performed by the thoracic surgery service at one Veterans Administration (VA) Medical Center. Results During a period of 107 months, 416 thoracic operations were performed, 211 of them for lung cancer. Stage distribution was 66% stage I, 18% stage II, 12% stage III, and 4% stage IV. During follow-up, 102 patients died, 57 of them from disease-specific causes. Median survival was 39 months for stage I. Disease-specific median survival was 83 months for stage I, and 5-year survival was 52% (72% for stage IA and 32% for stage IB). Conclusions Pulmonary resection offers high disease-free survival for early-stage lung cancer. Decentralized hospital computer programming (DHCP) allows individual oncology programs to reliably measure survival. Use of this important outcome measure in quality improvement programs facilitates realistic counseling of patients and meaningful assessments of practice effectiveness.

Diffusing capacity predicts operative mortality but not long-term survival after resection for lung cancer

Objectives: We sought to determine whether diffusing capacity influences operative mortality and long-term survival after resection for lung cancer. Methods: We retrospectively reviewed the case histories of patients who underwent major resection for lung cancer. The association between operative mortality and predicted postoperative diffusing capacity was examined. Long-term survival among operative survivors was compared between the groups with high and low predicted postoperative diffusing capacity. Results: The group comprised 410 patients with a mean age of 62.3 years. We performed 273 lobectomies, 35 bilobectomies, and 102 pneumonectomies. A total of 32 operative deaths (7.8%) were associated with low predicted postoperative diffusing capacity ( P < .001). If we examine only operative survivors, there is no significant difference in survival data between patients with a predicted postoperative diffusing capacity of less than 50 and those with a predicted figure of 50 or more (stage I, 111 vs 90 months; stage II, 26 vs 32 months; stage IIIa 32 vs 26 months; log rank P > .5 for each). On the basis of the Cox proportional hazards model, predicted postoperative diffusing capacity did not have a statistically significant effect on long-term survival (estimated hazard ratio corresponding to a 20-point decrease in predicted postoperative diffusing capacity = 1.13; 95% confidence interval: 0.92 to 1.37). Conclusion: A poor diffusing capacity is associated with high operative mortality but does not adversely affect long-term survival after major lung resection among operative survivors. Improving the perioperative management of patients undergoing major lung resection may enable inclusion of more patients with reduced diffusing capacity in the candidate pool for surgery, thus maximizing survival for early-stage lung cancer. (J Thorac Cardiovasc Surg 1999;117:581-7)