National Cancer Institute Home at the National Institutes of Health | www.cancer.gov
Please wait while this form is being loaded....
The Applied Research Program Web site is no longer maintained. ARP's former staff have moved to the new Healthcare Delivery Research Program, the Behavioral Research Program, or the Epidemiology & Genetics Research Program, and the content from this Web site is being moved to one of those sites as appropriate. Please update your links and bookmarks!

Publication Abstract

Authors: Farjah F, Wood DE, Varghese TK Jr, Symons RG, Flum DR

Title: Trends in the operative management and outcomes of T4 lung cancer.

Journal: Ann Thorac Surg 86(2):368-74

Date: 2008 Aug

Abstract: BACKGROUND: This study describes temporal trends and variables in the operative management and outcomes of patients with T4 lung tumors in the general community. METHODS: Surveillance, Epidemiology, and End-Results-Medicare data were used for a cohort study (1992 to 2002) of patients with stage IIIB lung cancer defined by T4 tumors. Patient characteristics, tumor size, nodal status, use of staging modalities, extent of resection, multi-modality therapy, and provider volume were examined. Follow-up death data were available through 2005. RESULTS: Among 13,077 cases of T4 lung tumors, 1177 patients (9%) underwent resection. Over time, use of mediastinoscopy (20%) did not change (p = 0.49); mediastinal lymphadenectomy increased from 10% to 29% (p < 0.001) and neoadjuvant therapy from 4% to 8% (p = 0.04). Five-year survival rates increased from 15% to 35% (p < 0.001). A higher hazard of death was associated with increasing age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00 to 1.03), comorbidity index of 3 vs 0 (HR, 1.66; 95% CI 1.24 to 2.21), tumor size 3 cm or more (HR, 1.55; 95% CI, 1.30 to 1.84), N2/N3 nodes (HR, 1.67; 95% CI, 1.40 to 1.98), and sublobar resection (HR, 1.55; 95% CI, 1.26 to 1.90). Mediastinal lymphadenectomy had a significantly lower hazard of death (HR, 0.78; 95% CI, 0.64 to 0.95). Improvements in overall survival over time persisted after adjustment for these factors (p = 0.007). CONCLUSIONS: Temporal changes in the operative management of T4 tumors coincided with improvements in long-term survival. Our findings corroborate prior work and practice guidelines supporting operative therapy for select patients with T4 lung cancer.

Last Modified: 03 Sep 2013