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Factors affecting survival in non-small cell lung cancer invading the chest wall

Abidin Sehitogullari, Yusuf Aydemir, Fuat Sayir

Aim: The current study aimed to evaluate the factors affecting survival in non-small cell lung cancer invading the chest wall.

Method: A total of 45 cases operated on for Non-Small Cell Lung Cancer invading the chest wall (NSCLC) were followed-up for five years. The effects of factors such as depth of tumor invasion of the chest wall (parietal pleura, extra pleural fatty tissue, intercostal muscles, and rib involvement), perinodal involvement, “N” involvement, surgical margin of the resection, and adjuvant chemotherapy on prognosis and survival were evaluated.

Results and Discussion: The number of males and females among the cases was 38 (84%) and seven (16%), respectively, with a mean age of 55 ± 8 years (42-74). Chest wall resection and extra-pleural resection was performed in 36 (80%) and nine (20%) cases, respectively. In the multivariate analysis, factors positively affecting survival were depth of invasion, tumor dimension less than 5 cm, N0 lymph node status, complete resection, and complete adjuvant chemotherapy. Full-thickness resection of the chest wall was an important prognostic factor for long-term survival in all patients with NSCLC invading the chest wall.

Conclusion: The stage of the tumor and histopathological factors such as lymphatic involvement, extrapleural invasion, and rib invasion have been shown to gain importance in improvement of survival, in addition to advancements in surgical techniques. Although there is no consensus on the surgical approach in presence of chest wall invasion, we suggest that “en bloc” resection should be preferred to extra-pleural resection.