Prognostic factors after pneumonectomy in lung cancer

Hintergrund For selected lung cancer patients pneumonectomy is a potentially curative treatment option. However increased morbidity and mortality has been described, thus prognostic factors for treatment personalization are of importance. Thus, the purpose of this study was to analyze the prognostic factors affecting the overall survival of patients undergoing pneumonectomy for lung cancer.

Material und Methode Clinicopathological data of lung cancer patients who underwent pneumonectomy between 2013 and 2018 were reviewed retrospectively. We analyzed median overall survival and three and five-year survival and compared with all clinicopathologic data and laboratory tests, including age, gender, smoking history, body-mass-index (BMI), forced expiratory volume in 1 second (FEV1%), diffusion capacity of the lung to carbon monoxide (DLCO%), leukocyte count, CRP, LDH, modified Glasgow prognostic score (mGPS), side of the operation, size of the tumor, preoperative treatment, disease stage and histology. Both univariable and multivariable analysis was performed.

Ergebnis 103 consecutive patients (70 male, 33 female) with a median age of 62 years (range 44 – 86 years) were included. The median overall survival was 4.7 years with 54% 3-year and 49% 5-year survival. Age, gender, BMI, FEV1%, DLCO%, side of operation, tumor size, mGPS, preoperative WBC, CRP and LDH did not affect overall survival. Neoadjuvant chemotherapy and chemoradiation was delivered to 15 and 46 patients, respectively. Patients with neoadjuvant therapy (n=61) (HR 0.4, p=0.0016), pathological stage IIIB-IV (1.9 vs 6 years, p=0.035) had a worse overall survival in univariable analysis. Squamous cell carcinoma patients (n=50) had significantly better survival than adenocarcinoma patients (n=41) (HR 1.894, p= 0.0378). In multivariable analysis of the three prognostic parameter, neoadjuvant therapy remained a significant independent prognosticator (p=0.005).

Schlussfolgerung Pneumonectomy for selected patients even after neoadjuvant therapy may provide long overall survival. Nevertheless, neoadjuvant therapy, advanced disease and adenocarcinoma histology were prognostic factors associated with shorter overall survival after pneumonectomy.

Immuntherapie und Thoraxchirurgie

 

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Artikel online veröffentlicht:
13. September 2022