2. Depth of Chest Wall Invasion By Lung Cancer Does Not Influence Survival

Robert J. Downey, Nael Martini, Valerie Rusch, Manjit Bains, Robert Ginsberg

Memorial Sloan-Kettering Cancer Center

New York, N.Y.

The long-term survival after surgery of patients with lung cancer invading the chest wall is known to be related to regional nodal involvement, and completeness of resection, but it is not known whether the depth of chest wall involvement influences prognosis. To access the importance of these variables, we retrospectively reviewed the Memorial Sloan-Kettering Center experience between 1974 and 1993 with resections performed with curative intent of lung cancer invading the chest wall.

Results: Of 334 patients explored, 175 underwent apparently complete resections, 94 incomplete resections and 65 were explored without resection. Resection was lobectomy/bilobectomy in 180 patients, pneumonectomy in 39, wedge/segmentectomy in 50. Interstitial implants of isotopes were used in 80 patients. The five and 10-year Kaplan-Meier overall survival following complete resection was 36 percent and 32 percent, respectively (median 16 months). Survival following incomplete resection was lower, even if the residual tumor was microscopic (five year 24 percent; median nine months). Five year survival in patients undergoing complete resection with T3N0M0 disease was 50 percent, and, in patients with T3N2M0 disease, 15 percent (p=0.0003). In those undergoing complete resection, the extent of chest wall invasion was limited to the parietal pleura in 95 patients, and extended into ribs and soft tissues in 80. No statistically significant survival advantage was observed among patients without lymph node metastases and with apparently completely resected disease, if the chest wall involvement was limited to the parietal pleura only (five-year 58 percent) rather than invading into the ribs and musculature (five year 44 percent) (p=0.18).

Conclusions: Survival after resection with curative intent of lung cancer invading the chest wall depends on regional nodal status and completeness of resection, not on the depth of chest wall invasion.