The Influence of Induction Chemotherapy in Surgical Resected pT4 Lung Cancer

BACKGROUND: To evaluate in a continuos series of pT4 lung cancer: a) impact of induction chemotherapy (IndCT) on postoperative outcome, and b) survival; c) survival based on pathological nodal status with or without IndCT. METHODS: Retrospective study. Fisher’s exact test for postoperative outcome analysis; survival calculated by Kaplan Meier method and log-rank test; Cox method for multivariate analysis. RESULTS: Between May 1998 until April 2004, 62 patients with pT4 (superior vena cava, n=12; trachea, n=7; aorta, n=5; left atrium, n=7; pulmonary artery, n=3; vertebral body, n=4; innominate vein, n=2; multiple nodules, n=22) non small-cell lung cancer were operated on. Thirty-six patients (58%) underwent IndCT. Nodal status was N0 in 17 patients, N1 in 17, and N2 in 28, respectively. Postoperative morbidity-mortality rates were 30% and 11% respectively. Five-year survival rate was 32% (median, 15 months). IndCT did not influence postoperative morbidity (p=0.26) and mortality (p=0.43). Concerning survival, neither IndCT (p=0.55), nor nodal status (i.e. pN0-N1 group versus pN2 group - p=0.46) influence the prognosis. However, patients with best prognosis were those with pN0-N1 after IndCT. Completeness of resection didn’t influence survival. At multivariate analysis was not identified any prognostic factor. CONCLUSIONS: Patients with pT4 lung cancer can benefit from surgical resection; IndCT does not increase the postoperative morbidity-mortality. The best candidates are those without mediastinal lymph-nodes involvement treated with IndCT.