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Surgical Treatment Of A Second Metachronous Non-Small Cell Lung Cancer (NSCLC)
Masatsugu Hamaji1, K Robert Shen2, Stephen D Cassivi2, Mark S Allen2, Francis C Nichols2, Claude Deschamps2, Dennis A Wigle2
1Brigham and Women's hospital, Boston, MA;2Mayo Clinic, Rochester, MN

OBJECTIVES: To clarify the perioperative and oncologic outcome of pulmonary resection for a second metachronous non-small cell lung cancer (NSCLC) following resection of an initial NSCLC.
METHODS: Through retrospective chart review 161 patients were identified as having undergone pulmonary resection for a second metachronous NSCLC between January 2000 and December 2009. There were 88 men and 73 women with a median age of 70 (range 34 to 88) years. Operative morbidity, mortality and relevant factors for morbidity were analyzed with chi-square test or Fisher’s exact test and Mann-Whitney test. Survival following resection of a second metachronous NSCLC was analyzed with Kaplan-Meier and Cox proportional hazard method.
RESULTS: The median interval between the initial and metachronous NSCLC resection was 42.7 months (range 7-205 months). Resection of the initial NSCLC was with lobectomy in 126 patients (78.3%), sublobar resection in 28 (17.4%), and pneumonectomy in 7 (4.3%). Resection of the metachronous NSCLC was with lobectomy in 36 (22.4%), sublobar resection in 124 (77%), and completion pneumonectomy in 1 (0.6%). The metachronous lesions included 119 (73.9%) adenocarcinomas and 41 (25.5%) squamous cell carcinomas and were the same histology as the original cancer in 123 (76.4%), while 38 (23.6%) were different. There was no operative mortality and postoperative complications occurred in 47 (29%) patients. In multivariate analysis, ipsilateral operation (p=0.0002) and a lower preoperative FEV1% predicted (p=0.0035) were significant risk factors for postoperative complications. Five-year survival rates after pulmonary resection of the initial and second metachronous NSCLC were 87.4% and 60.8%, respectively. Significant negative long-term prognostic factors for survival following resection of a metachronous NSCLC in multivariate analysis were tumor size > 2 cm (p=0.0001) and a different histology from the initial NSCLC (p=0.030). Metastatic nodal disease (p=0.19) or a sublobar resection (p=0.17) were not significant negative prognostic factors.
CONCLUSIONS: Surgical treatment of a second metachronous NSCLC can be undertaken with five-year expected survival rates of 60%. Selection of patients with tumors 2cm or smaller and with the same histology as the initial NSCLC will lead to better survival following resection. For a metachronous NSCLC, sublobar resection is acceptable when anatomically possible.


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