Squamous Cell Cancer of the Lung

5/12/00 (Del Rio)

Group: Friday Interns

RE: A 71 year old female with stage IIIA squamous cell lung cancer, presenting with left sided chest pain, cough, and fever,

Question: What is the 5-year survival rate for different treatment modalities in squamous cell cancer of the lung?

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Link Directly to Fulltext Article at Science Direct

Unique Identifier: 20212821

Authors: Bernet F. Brodbeck R. Guenin MO. Schupfer G. Habicht JM. Stulz PM. Carrel TP.

Institution: Division of Cardiothoracic Surgery and Institute for Anesthesiology, University Hospital Basel, Switzerland.

Abstract: BACKGROUND: The influence of age on early and late outcome after surgical resection of bronchogenic carcinoma: is unknown. In an attempt to clarify this issue, we reviewed the outcome of 212 consecutive patients with primary lung: cancer who had surgical treatment for bronchogenic carcinoma. METHODS: Ninety-two patients were younger than: 50 years (group 1), and 120 patients were older than 70 years of age (group 2). Squamous cell carcinoma and: adenocarcinoma were the most common histologic types in both groups. According to the new international staging: classification, a similar proportion of stage I, II, and III were observed in both groups. RESULTS: Only the rate of: pneumonectomy was significantly higher in younger patients (41% versus 22%, p = 0.002). The overall operative: mortality rate in group 1 was 2.2% and 2.6% after pneumonectomy. In group 2 the overall mortality rate was 2.5%: and 3.8% after pneumonectomy. Advanced age did not affect operative mortality. The adjusted (tumor-related): survival rate at 5 years was 56% in group 1 and 53% in group 2 (p = 0.93). The adjusted survival rate for patients: with stage I was 61% in group 1 and 65% in group 2 (p = 0.21), and for stage IIIa 39% in group 1 and 48% in group 2: (p = 0.43). The adjusted 5-year survival rate was 56% in group 1 and 59% in group 2 for squamous cell carcinoma: (p = 0.53) and 49% in group 1 and 42% in group 2 for adenocarcinoma (p = 0.76). CONCLUSIONS: Perioperative: risk and midterm survival were similar in younger and older patients after surgical resection of bronchogenic carcinoma.: We believe that this result is because surgical candidates constitute already a highly selected group of patients. From: these data it is not possible to conclude that biologic behavior of lung cancer is more aggressive in younger patients.: [References: 26]

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Link Directly to Fulltext article in Ovid

Unique Identifier: 20135788

Authors: van Rens MT. de la Riviere AB. Elbers HR. van Den Bosch JM.

Institution: Departments of Pulmonary Diseases, Sint Antonius Hospital, Nieuwegein, The Netherlands.

Abstract: STUDY OBJECTIVES: Staging and classification in lung cancer are important for both patient management and: clinical research. Results of survival after resection in patients with primary non-small cell lung cancer (NSCLC) are: analyzed in order to validate recent refinements of the staging system. DESIGN: Retrospective study; period from: 1970 to 1992; follow-up > or = 5 years. PATIENTS: A total of 2,361 previously untreated patients who underwent: resection for stage I, II, or IIIA primary NSCLC. MEASUREMENTS: Survival was estimated from the date of: operation using the Kaplan-Meier survival analysis method. Deaths within 30 days of operation were excluded.: Survival comparisons of different surgical-pathologic TNM classification (based on pathologic examination of: resected specimens) as well as further discriminative factors were analyzed by log-rank test. RESULTS: Postoperative: death occurred in 3.9% of patients. For survival analyses, 2,263 patients were included. The overall 5-year survival: was 937/2,263 (41.4%). Five-year survival in stage IA was 255/404 (63%); in stage IB, 367/797 (46%); in stage: IIA, 43/83 (52%); in stage IIB, 210/642 (33%); and in stage IIIA, 63/337 (19%). No significant difference in survival: was demonstrated between stages IB and IIA. Until 4 years after surgery, age at operation did not influence survival;: after 5 years, patients > 65 years old had a significantly lower survival. CONCLUSION: The TNM staging system: accurately reflects the prognosis in primary NSCLC, but some stage definitions can be discussed. Despite the fact that: the staging system is built on clinical data, the present analysis, which includes postsurgical data, confirms the similar: survival of patients with T2N0M0 and T1N1M0. These results also stress the use of two separate substages,: especially because these patients are offered surgery when possible.

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Link Directly to Fulltext Article at Publisher

Unique Identifier: 20016317

Authors: Fry WA. Phillips JL. Menck HR.

Institution: Department of Clinical Surgery, Northwestern University Medical School and Section of Thoracic Surgery, Evanston: Northwestern Healthcare, Evanston, Illinois, USA.

Abstract: BACKGROUND: Primary lung cancer accounts for approximately 14% of all new cancers and 28% of cancer deaths: in the U.S. Previous reviews have shown limited progress in the management or outcome of this devastating disease.: METHODS: Reports described in the current study were 713,043 primary lung malignancies diagnosed between: 1985 and 1995 and submitted to the National Cancer Data Base. Demographic, tumor, and treatment patterns for: 1995 were compared with those for 1985-1987, 1988-1991, and 1992-1994. Ten-year relative survival rates were: presented for selected demographic and histologic groups and 5-year relative survival rates were presented by stage: and dominant treatment modalities for major carcinoma histologies. RESULTS: Previously observed demographic: trends were evident, with increasing proportions of patients being older, female, and African American, and more cases: reported to be adenocarcinomas. There was a substantial shift toward more complete staging but no change in the: distribution of staged cases. Compared with earlier patients, fewer 1995 patients received cancer-directed treatment.: More surgical patients underwent lymph node dissection, and radiation treatment was supplemented more often with: chemotherapy. The overall 10-year relative survival rate was 7%. The 5-year survival for American Joint: Committee on Cancer Stage I surgical patients was >50% for all nonsmall cell histologic groups. CONCLUSIONS:: Recent shifts in treatment, although minimal, are consistent with current literature concerning the effectiveness of lung: carcinoma treatment. The authors believe that the overall poor survival of lung carcinoma patients points to a: continuing need for improved prevention and treatment measures. The comparatively superior survival of Stage I: nonsmall cell lung carcinoma surgical patients indicates that a substantial number of patients have the potential to be: treated successfully. Copyright 1999 American Cancer Society.