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Ann Thorac Surg. 2017 Dec;104(6):1829-1836. doi: 10.1016/j.athoracsur.2017.06.073. Epub 2017 Nov 1.

Fate of Pneumonectomy Patients Variably Captured by Non-Small Cell Lung Cancer Staging System.

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Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Cancer Outcomes, Public Policy, and Effectiveness Research Center, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut. Electronic address:



Lung cancer patients rely on survival estimates to weigh risks and benefits of treatment. However, pneumonectomy-requiring lung cancer may have inherent oncologic or physiologic survival implications not captured by the current stage classification. Stage-specific survival was evaluated to refine survival expectations for patients with pneumonectomy-requiring disease.


The National Cancer Database was queried for treatment-naive patients who underwent lobectomy or pneumonectomy for stage I to III non-small cell lung cancer between 2004 and 2013. Patients who died within 90 days after resection were excluded. Three-way propensity score weighted multivariable Cox models were built and incorporated into adjusted 5-year overall survival (OS) curves.


A total of 79,953 patients met inclusion criteria: 75,708 lobectomies (95%) and 4,245 pneumonectomies (5%). Stage I and II patients undergoing right pneumonectomy had worse adjusted 5-year OS than patients undergoing left pneumonectomy, which was worse than lobectomy (stage I: 55%, 58%, 67%; stage II: 37%, 44%, 48%; indicating right pneumonectomy, left pneumonectomy, lobectomy). Stage III right pneumonectomy patients had worse adjusted 5-year OS; however, left pneumonectomy and lobectomy patients were similar (33%, 39%, 40%). A doubly robust Cox model identified a similar pattern for mortality risk for stage I and II (right pneumonectomy > left > lobectomy); however, stage III right pneumonectomy patients had higher mortality risk than lobectomy patients (hazard ratio [HR] 1.23, 95% confidence interval [CI]: 1.17 to 1.28, p < 0.001), whereas left pneumonectomy was similar to lobectomy (HR 1.02, 95% CI: 0.97 to 1.06, p = 0.47).


Pneumonectomy-requiring lung cancer embodies a 5-year mortality risk not completely captured by the lung cancer staging system. Refined survival estimates for pneumonectomy patients may enhance shared decision making in this population.

[Indexed for MEDLINE]

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