Good clinical outcomes are possible after surgery for high-risk patients with early stage lung cancer, according to an article published online ahead of print in the journal The Annals of Thoracic Surgery.1

Patients with early stage lung cancer who are categorized as high-risk are more frequently being treated with nonsurgical therapies. However, the definition of high risk varies. Researchers sought to compare clinical outcomes of high-risk vs standard-risk patients following surgical resection.

For this study, high-risk was defined using the ACOSOG z4032/z4099 criteria: forced expiratory volume in 1 second (FEV1) 50% or less or diffusing capacity of lung for carbon monoxide (DLCO), and 2 of the following—age 75 years or higher, FEV1 51% to 60%, or DLCO 51% to 60% .

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Researchers took data from the Society of Thoracic Surgeons, and included a total of 490 patients who had undergone resection from 2009 to 2013. They identified 180 patients (37%) as high risk.

Those patients tended to be older than standard-risk patients, had worse FEV1, had more smoking pack-years, and a greater incidence of chronic obstructive pulmonary disease. High-risk patients also were more likely to undergo sublobar resection.

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Results demonstrated that although high-risk patients had a longer hospital stay (5 vs 4 days; P < .0001), there was no difference in postoperative mortality (2% vs1%; P = .53).

Surgery led to nodal upstaging in 20% of high-risk patients vs 21% in standard-risk patients (P = .79). High-risk patients had a 3-year survival rate of 59% vs 76% for standard-risk patients (P < .0001).


  1. Sancheti MS, Melvan HN, Medbery RL, et al. Outcomes after surgery in high-risk patients with early stage lung cancer [published online ahead of print November 9, 2015]. Ann Thorac Surg. doi: 10.1016/j.athoracsur.2015.08.088.