J Cancer 2017; 8(11):2097-2103. doi:10.7150/jca.19454

Research Paper

Comprehensive study of prognostic risk factors of patients underwent pneumonectomy

Chang Gu1, Rui Wang 1, Xufeng Pan1, Qingyuan Huang1, Jizhuang Luo1, Jiajie Zheng1, Yiyang Wang1, Jianxin Shi1✉, Haiquan Chen1,2✉

1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
2. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
Chang Gu, Rui Wang and Xufeng Pan contributed equally to this work.

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Gu C, Wang R, Pan X, Huang Q, Luo J, Zheng J, Wang Y, Shi J, Chen H. Comprehensive study of prognostic risk factors of patients underwent pneumonectomy. J Cancer 2017; 8(11):2097-2103. doi:10.7150/jca.19454. Available from http://www.jcancer.org/v08p2097.htm

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Introduction: To investigate postoperative complications and the prognostic risk factors of patients underwent pneumonectomy.

Methods: Four hundred and six patients underwent pneumonectomy were subjected to the study. All the clinicopathologic data including age, gender, smoking history, surgical treatment, postoperative complications, tumor staging and the follow-up information were investigated.

Results: The 30-day and 90-day mortality rates were 3.2% and 6.2%, respectively. Postoperative complications developed in 149 patients (36.7%), mainly included arrhythmia, transfusion, pulmonary infection, bronchopleural fistula and acute respiratory distress syndrome. During the follow-up, 189 patients experienced a relapse, consisting of 51 patients with local recurrence and 138 with distant recurrence. The median survival time was 24.4 months and the overall 1-year, 3-year and 5-year survival rates were 82.7%, 50.9% and 32.5%, respectively. Moreover, the overall 1-year, 3-year, 5-year survival rates for patients with non-small cell lung cancer (NSCLC) were 84.1%, 52.1% and 32.5%, respectively and patients with small cell lung cancer (SCLC) were 56.1%, 38.5% and 28.8%, respectively. Among NSCLCs, adenocarcinomas had a worse prognosis than squamous carcinomas. Compared to right pneumonectomy, patients with left pneumonectomy had a better prognosis. Multivariable analysis revealed ICU stay, disease stage, nodal stage and adjuvant chemotherapy were all significant predictors of overall survival (OS).

Conclusions: Pneumonectomy is still a valuable and effective treatment option for patients with advanced lung cancer. Surgeons should be more cautious when patients had higher disease stage, adenocarcinoma and right-side lung cancer. Neoadjuvant chemotherapy did not affect the prognosis. Pneumonectomy could also achieve acceptable survival outcomes in well-selected SCLC patients.

Keywords: Pneumonectomy, Prognosis, Small cell lung cancer, Non-small cell lung cancer