, Volume 186, Issue 2, pp 97–102

Predicting Survival in Potentially Curable Lung Cancer Patients

  • Thida Win
  • Linda Sharples
  • Ashley M. Groves
  • Andrew J. Ritchie
  • Francis C. Wells
  • Clare M. Laroche


Lung cancer is the most common cause of cancer death with unchanged mortality for 50 years. Only localized nonsmall-cell lung cancer (NSCLC) is curable. In these patients it is essential to accurately predict survival to help identify those that will benefit from treatment and those at risk of relapse. Despite needing this clinical information, prospective data are lacking. We therefore prospectively identified prognostic factors in patients with potentially curable lung cancer. Over 2 years, 110 consecutive patients with confirmed localized NSCLC (stages 1–3A) were recruited from a single tertiary center. Prognostic factors investigated included age, gender, body mass index (BMI), performance status, comorbidity, disease stage, quality of life, and respiratory physiology. Patients were followed up for 3-5 years and mortality recorded. The data were analyzed using survival analysis methods. Twenty-eight patients died within 1 year, 15 patients died within 2 years, and 11 patients died within 3 years postsurgery. Kaplan-Meier survival estimates show a survival rate of 51% at 3 years. Factors significantly (p < 0.05) associated with poor overall survival were age at assessment, diabetes, serum albumin, peak VO2 max, shuttle walk distance, and predicted postoperative transfer factor. In multiple-variable survival models, the strongest predictors of survival overall were diabetes and shuttle walk distance. The results show that potentially curable lung cancer patients should not be discriminated against with respect to weight and smoking history. Careful attention is required when managing patients with diabetes. Respiratory physiologic measurements were of limited value in predicting long-term survival after lung cancer surgery.


Carcinoma Bronchogenic Prognosis Diagnostic tests 


  1. 1.
    van Rens MT, de la Riviere AB, Elbers HR, van Den Bosch JM (2000) Prognostic assessment of 2,361 patients who underwent pulmonary resection for non-small cell lung cancer, stage I, II, and IIIA. Chest 117:374–379PubMedCrossRefGoogle Scholar
  2. 2.
    Suzuki K, Nagai K, Yoshida J, Nishimura M, Takahashi K, Yokose T, Nishiwaki Y (1999) Conventional clinicopathologic prognostic factors in surgically resected nonsmall cell lung carcinoma. A comparison of prognostic factors for each pathologic TNM stage based on multivariate analyses. Cancer 86:1976–1984PubMedCrossRefGoogle Scholar
  3. 3.
    Fang D, Zhang D, Huang G, Zhang R, Wang L, Zhang D (2001) Results of surgical resection of patients with primary lung cancer: a retrospective analysis of 1,905 cases. Ann Thorac Surg 72:1155–1159PubMedCrossRefGoogle Scholar
  4. 4.
    Batevik R, Grong K, Segadal L, Stangeland L (2005) The female gender has a positive effect on survival independent of background life expectancy following surgical resection of primary non-small cell lung cancer: a study of absolute and relative survival over 15 years. Lung Cancer 47:173–181PubMedCrossRefGoogle Scholar
  5. 5.
    Yamamoto K, Padilla Alarcon J, Calvo Medina V, Garcia-Zarza A, Pastor Guillen J, Blasco Armengod E, Paris Romeu F (2003) Surgical results of stage I non-small cell lung cancer: comparison between elderly and younger patients. Eur J Cardiothorac Surg 23:21–25PubMedCrossRefGoogle Scholar
  6. 6.
    Beckles MA, Spiro SG, Colice GL, Rudd RM; American College of Chest Physicians (2003) The physiologic evaluation of patients with lung cancer being considered for resectional surgery. Chest 123:105S–114SPubMedCrossRefGoogle Scholar
  7. 7.
    British Thoracic Society: Society of Cardiothoracic Surgeons of Great Britain, Ireland Working Party (2001) BTS guidelines: guidelines on the selection of patients with lung cancer for surgery. Thorax 56:89–108CrossRefGoogle Scholar
  8. 8.
    AJCC (2002) Cancer staging handbook, 6th ed. New York: Springer, pp 189–209Google Scholar
  9. 9.
    Northridge DB, Grant S, Ford I, Christie J, McLenachan J, Connelly D, McMurray J, Ray S, Henderson E, Dargie HJ (1990) Novel exercise protocol suitable for use on a treadmill or a bicycle ergometer. Br Heart J 64:313–316PubMedCrossRefGoogle Scholar
  10. 10.
    Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE (1992) Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 47:1019–1024PubMedCrossRefGoogle Scholar
  11. 11.
    Win T, Tasker AD, Groves AM, White C, Ritchie AJ, Well FC, Laroche CM (2006) Ventilation-perfusion scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing pneumonectomy. AJR Am J Roentengol 187:1260-1265CrossRefGoogle Scholar
  12. 12.
    Pierce RJ, Copland JM, Sharpe K, Barter CE (1994) Preoperative risk evaluation for lung cancer resection: predicted postoperative product as a predictor of surgical mortality. Am J Respir Crit Care Med 150:947–955PubMedGoogle Scholar
  13. 13.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376 PubMedCrossRefGoogle Scholar
  14. 14.
    Naruke T, Tsuchiya R, Kondo H, Asamura H (2001) Prognosis and survival after resection for bronchogenic carcinoma based on the 1997 TNM-staging classification: the Japanese experience. Ann Thorac Surg 71(6):1759–1764PubMedCrossRefGoogle Scholar
  15. 15.
    Goya T, Asamura H, Yoshimura H, Kato H, Shimokata K, Tsuchiya R, Sohara Y, Miya T, Miyaoka E; The Japanese Joint Committee of Lung Cancer Registry (2005) Prognosis of 6644 resected non-small cell lung cancers in Japan: a Japanase lung cancer registry study. Lung Cancer 50(2):227–234PubMedCrossRefGoogle Scholar
  16. 16.
    Pfannschmidt J, Muley T, Bulzebruck H, Hoffmann H, Dienemann H (2007) Prognostic assessment after surgical resection for non small cell lung cancer experience in 2083 patients. Lung Cancer 55(3):371–377PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Thida Win
    • 1
    • 2
  • Linda Sharples
    • 3
  • Ashley M. Groves
    • 4
  • Andrew J. Ritchie
    • 5
  • Francis C. Wells
    • 5
  • Clare M. Laroche
    • 1
  1. 1.Thoracic Oncology UnitPapworth HospitalCambridgeUK
  2. 2.Lister HospitalStevenageUK
  3. 3.MRC Biostatistics UnitCambridgeUK
  4. 4.Institute of Nuclear MedicineUniversity College LondonLondonUK
  5. 5.Department of Cardiothoracic SurgeryPapworth HospitalCambridgeUK

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