to assess the prognostic factors and outcome of primary lung cancers (PLCs) discovered as solitary pulmonary nodules (SPNs).
between 1999 and 2003 314 patients (223 male-71%-, mean age 64 years-range 21-81 years-) underwent surgical resection of a SPN. Of these 209 (66%) were PLCs, 56 (17%) lung metastases and 49 benign lesions.
One hundred and ten (75%) out of 209 PLCs were adenocarcinomas, 58 (18.7%) squamous cell carcinomas, 12 bronchioloalveolar carcinomas, 8 large cell carcinomas and 12 bronchial carcinoids. Nine patients had mixed tumors. Twenty-six (12.6%) were less than 1 cm. in size; 100 (47.5%) between 1.1 and 2 cm, and 83 (39.9%) between 2.1 and 3 cm. One hundred thirty-seven (65.7%) were N0; 25(11.9%) were N1 and N2, respectively; in 22 (10.5%) lymphadenectomy was not performed. Three and five year overall survival rates were 70% and 52%, respectively. The following prognostic variables resulted statistically significant at multivariate analysis: the tumor histology (p=0.0005), the tumor size (p=0.007), the presence of lymphnodal metastases (p=0.00001), the visceral pleura invasion (p=0.0002) and the extent of resection (anatomic vs. limited resection) (p=0.004).
this is a surgical series with a high PLCs percentage (66%), the majority of which were at early stage. An early diagnosis and surgical treatment represent the treatment of choice, especially in high risk patients, providing a good survival.
in high risk patients PLC should be considered in occasionally discovered SPN. Early diagnosis and possible surgical treatment are mandatory.
Pier Luigi Filosso, None.