Prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer

Abstract

Background The prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer (NSCLC) remains unclear. This study intends to identify the prognostic factors and to optimize treatments for these patients under update conditions. Methods The data of 124 NSCLC patients who underwent R1-resection at the bronchial stump was reviewed. There were 41 patients in the surgery group (S), 21 in the postoperative radiotherapy (PORT) group (S+R), 30 in the postoperative chemotherapy (POCT) group (S+C), and 32 in the PORT plus POCT group (S+R+C). The constitute proportion in different groups was tested using the χ2 method, univariate analysis was performed using the Kaplan-Meier and log-rank method, and multivariate analysis was done using the Cox hazard regression with entry factors including age, sex, pathological type and stage, classification of the residual disease, and treatment procedure. The process was performed stepwise backward with a maximum iteration of 20 and an entry possibility of 0.05 as well as an excluded possibility of 0.10 at each step. Results In univariate analysis, survival was more favorable for patients with squamous cell carcinoma, early pathological T or N stage, and chemotherapy or radiotherapy. There was no significant difference in the survival for patients with different types of the residual disease, except for the difference between patients with carcinoma in situ and lymphangiosis carcinomatosa (P=0.030). The survival for patients receiving chemoradiotherapy was superior to that for those undergoing surgery alone (P=0.016). In multivariate analysis, the pathological type (HR 2.51, 95% CI 1.59 to 3.96, P=0.000), pathological T (HR 1.29, 95% CI 1.04 to 1.60, P=0.021) or N stage (HR 2.04, 95% CI 1.40 to 2.98, P=0.000), and chemotherapy (HR 0.24, 95% CI 0.13 to 0.43, P=0.000) were independent prognostic factors. Conclusion Patients with squamous cell carcinoma, early pathological T or N stage, or receiving chemotherapy had a more favorable prognosis.