Marginal pulmonary function should not preclude lobectomy in selected patients with non-small cell lung cancer Journal Article


Authors: Taylor, M. D.; Lapar, D. J.; Isbell, J. M.; Kozower, B. D.; Lau, C. L.; Jones, D. R.
Article Title: Marginal pulmonary function should not preclude lobectomy in selected patients with non-small cell lung cancer
Abstract: Objective Current clinical trials are investigating the role of stereotactic body radiation therapy (SBRT) versus sublobar resection for patients with non-small cell lung carcinoma (NSCLC) and marginal pulmonary function tests (M-PFTs). We compared the outcomes of patients undergoing lobectomy with M-PFTs characterized by 2 accepted M-PFT criteria. Methods A total of 1,259 consecutive patients underwent lobectomy for NSCLC between 1999 and 2011. Patients were stratified into 2 classifications of M-PFT: American College of Surgeons Oncology Group (ACOSOG) Z4099/Radiation Therapy Oncology Group (RTOG) 1021 trial or American College of Chest Physicians (ACCP) criteria. There were 206 patients classified as having M-PFT according to ACOSOG Z4099/RTOG 1021 criteria and 131 patients classified as having M-PFT by ACCP criteria. The primary endpoints of the study were post-operative complications and survival. Results Median follow-up was 3.8 years. Cox-proportional survival analysis found that pathologic stage (P <.001), age (P <.001), and higher Zubrod functional status (P <.001) were independent predictors of mortality. Using multivariable analysis for major morbidity, M-PFT status was not associated with the development of a major complication following lobectomy (P =.68). M-PFT classification was not an independent predictor of mortality when controlling for other variables (ACOSOG Z4099/RTOG 1021 [P =.34]; ACCP criteria [P =.83]). A composite major morbidity analysis for major morbidity following lobectomy showed no association between clinicopathologic variables or M-PFTs and the occurrence of a major postoperative morbidity. Conclusions In carefully selected patients with M-PFTs, lobectomy for NSCLC can be performed with acceptable morbidity and mortality. These results need to be considered when deciding if a patient should undergo lobectomy or other therapies for resectable NSCLC. Copyright © 2014 by The American Association for Thoracic Surgery.
Keywords: cancer survival; controlled study; aged; major clinical study; follow up; prospective study; lung non small cell cancer; morbidity; retrospective study; postoperative complication; cancer classification; stereotactic body radiation therapy; lung function test; lobectomy; functional status; human; male; female; priority journal; article
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 147
Issue: 2
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 2014-02-01
Start Page: 738
End Page: 746
Language: English
DOI: 10.1016/j.jtcvs.2013.09.064
PROVIDER: scopus
PUBMED: 24252944
DOI/URL:
Notes: Export Date: 3 March 2014 -- CODEN: JTCSA -- Source: Scopus
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  1. David Randolph Jones
    205 Jones