Prognosis and End Results

Abstract

As detailed previously surgery offers the only major prospect of cure in non-small cell lung cancer. Of all patients presenting with this disease only 25% undergo thoracotomy following staging and, on average, about 5% of these subjects will still be unresectable despite a negative mediastinoscopy. This is almost always due to nodal involvement beyond the range of the mediastinoscope or tumor invading vital structures in the mediastinum. Thus about 20% of all patients will undergo a curative resection of which 4%–5% will be alive and tumor free at 5 years — a 25% 5-year survival rate overall for this selected group of resected patients (Fig.l). The other 15% of patients will die of local or distant recurrence within 5 years. The overall 5-year survival figure of 20%–30% and 10-year survival of 16%–18% (there is a significant falloff between 5 and 10 years due to metastatic spread from slowly growing lung cancers) has not changed during the last 30 years. These figures can, however, be somewhat misleading as they include 40%–50% of patients with stage I disease. In stage I disease the 2-year survival when staging was originally looked at by Mountain et al. in 1974 was 47% for squamous cell carcinoma (see Table 1).