Characteristics and prognosis of patients after resection of nonsmall cell lung carcinoma measuring 2 cm or less in greatest dimension

Abstract

BACKGROUND: There remains ongoing controversy with regard to the optimal management strategy and the prognostic significance of small-sized nonsmall cell lung carcinoma. Therefore, in the current study, the authors analyzed the clinical characteristics of patients who underwent complete resection of these lung tumors, the follow-up data, and the significant prognostic factors. METHODS: Of 1726 consecutive patients surgically treated for proven primary lung carcinoma, 265 patients underwent complete removal of a nonsmall cell lung carcinoma in which the greatest dimension of the resected specimen was < or = 2 cm. RESULTS: The cancer-specific 5-year and 10-year survival rates were 86% and 83%, respectively. Univariate analyses revealed that advanced pathologic stage, a tumor size of 16-20 mm, lymphatic vessel invasion, vascular vessel invasion, a high serum level of carcinoembryonic antigen (CEA), and extended resection were significantly unfavorable prognostic factors. Among these factors, multivariate analyses demonstrated that pathologic stage (P < 0.0001), vascular vessel invasion (P = 0.0040), and CEA level (P = 0.0291) were significant, independent determinants of survival. None of the patients with pathologic Stage I disease, no vascular vessel invasion, and a low serum CEA level died of their disease after undergoing complete resection. CONCLUSIONS: The preoperative level of serum CEA and vascular vessel invasion by tumor cells were found to be independent prognostic factors that were as significant as the well established determinant of pathologic stage for patients with a nonsmall cell lung carcinoma measuring < or = 2 cm in greatest dimension. These data may contribute to the explanation of the lower-than-expected survival of patients after complete surgical resection of such a small-sized tumor.