Trends in the Operative Management and Outcomes of T4 Lung Cancer

Background This study describes temporal trends and variables in the operative management and outcomes of patients with T4 lung tumors in the general community. Methods Surveillance, Epidemiology, and End-Results-Medicare data were used for a cohort study (1992 to 2002) of patients with stage IIIB lung cancer defined by T4 tumors. Patient characteristics, tumor size, nodal status, use of staging modalities, extent of resection, multi-modality therapy, and provider volume were examined. Follow-up death data were available through 2005. Results Among 13,077 cases of T4 lung tumors, 1177 patients (9%) underwent resection. Over time, use of mediastinoscopy (20%) did not change (p = 0.49); mediastinal lymphadenectomy increased from 10% to 29% (p < 0.001) and neoadjuvant therapy from 4% to 8% (p = 0.04). Five-year survival rates increased from 15% to 35% (p < 0.001). A higher hazard of death was associated with increasing age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00 to 1.03), comorbidity index of 3 vs 0 (HR, 1.66; 95% CI 1.24 to 2.21), tumor size 3 cm or more (HR, 1.55; 95% CI, 1.30 to 1.84), N2/N3 nodes (HR, 1.67; 95% CI, 1.40 to 1.98), and sublobar resection (HR, 1.55; 95% CI, 1.26 to 1.90). Mediastinal lymphadenectomy had a significantly lower hazard of death (HR, 0.78; 95% CI, 0.64 to 0.95). Improvements in overall survival over time persisted after adjustment for these factors (p = 0.007). Conclusions Temporal changes in the operative management of T4 tumors coincided with improvements in long-term survival. Our findings corroborate prior work and practice guidelines supporting operative therapy for select patients with T4 lung cancer.