제1기 폐암의 수술성적

Abstract

Background: Surgical resection is the standad therapy for the stage I lung cancer. We analysed the risk facturs of stage I lung cancer patent and tryed to establish more effective and aggressive treatment modality. Materials and methods: A detailed analysis was undertaken to evaluate the surgical results and to define the risk factors associated with the recurrence and the survival time in 146 consecutive patients with stage I lung cancer who were diagnosed, and resected at Yonsei Medical Center from January 1990 to December 1996. Results: There were 115 males and 31 females. Their ages ranged from 27 to 79 years(mean age:58.9±9.3 years). The histologic types were squamous carcinoma in 72 cases(49.3%) and adenocarcinoma in 45 cases(30.8%). A pulmonary resection and mediastinal lymph node dissection were done in all cases. A lobectomy was performed in 96 cases(65.7%) and a pneumonectomy in 48 cases(32.9%). There were 5 operative mortalities(3.4%) and complications occured in 24 cases(16.5%). The overall 5-year survival was 64.1%, and survival time did not depend on the type of operation or histologic type. Significant predictors of decreased survival were visceral pleural invasion(p=0.0079), T2 lesion(p=0.0462), and tumor size(≥5 cm) in adenocarcinoma(p=0.0472). The overall incidence of recurrence was 33.3%(47 cases; local or regional 6.4%, distant 26.9%). Almost all recurrences(44cases) occurred in T2 lesions. The distant organs that failed were the contralateral lung in 13 patients, the brain in 12, the bone in 10, and other organs in 3. Conclusions: even in stage I lung cancer, we suggest that postoperative adjuvant therapy is recommended in patients with poor prognostic factors such as visceral pleural invasion, T2 lesions, and a tumor size(≥5 cm) in the adenocarcinoma.