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Original Article

Surgical Treatment of Metachronous Nonsmall Cell Lung Cancer
Shuji Haraguchi, MD,1,2 Kiyoshi Koizumi, MD,1,2 Tomomi Hirata, MD,1,2 Kyoji Hirai, MD,1,2 Iwao Mikami, MD,1,2 Hirotoshi Kubokura, MD,1,2 Yuki Nakajima, MD,1,2 and Kazuo Shimizu, MD, FACS, FJCS2

Purpose: We report surgical results of metachronous nonsmall cell lung cancer (NSCLC). Methods: We report mortality andanalyze prognostic factors for overall survival in patients with metachronous NSCLC at Nippon Medical School from July 1982 to July 2008. Results: Thirty-three out of 1726 patients (1.9%) who underwent lung resection had metachronous NSCLC. Mortality rate was 10%. On univariate analyses, the different histologies at the first and second operations were the only significant poor prognostic factor.Twenty-two patients (73%) had the same histology at the first and second operations: adenocarcinoma in 18 (60%) and squamous cell carcinoma in 4 (13%). Their actuarial 5- and 10-year overall survivals were both 71%, compared to 47% and 16% for patients with different histology (p = 0.0174). Sex (p = 0.1742), locations of the first and second cancers (p = 0.3957), operative procedures in patientswith p-stage I at the second operation (p = 0.2782), pathological stage at the first operation (p = 0.5958), and pathological stage at the second operation (p = 0.0609) were not prognostic factors. Different histology at the first and second operations was significant based on a multivariate analysis (Hazard ratio: 3.918; p value: 0.0269; 95% confidence interval: 1.169–13.131). The actuarial 5- and10-year overall survivals for the first cancer was 86% and 64%, compared to 65% and 45% for the second (p = 0.0609). Conclusions: Our study shows that a surgical approach is beneficial for patients with metachronous NSCLC. Good prognosis in patients with the same histology may support the current criteria of metachronous NSCLC mainly based on the histology. (Ann Thorac Cardiovasc Surg 2010; 16:319–325) Key words: nonsmall cell lung cancer, metachronous carcinoma, mortality, prognosis

Introduction
The frequency of metachronous nonsmall cell lung cancer (NSCLC) has increased from 0.5% to 4.5%, probably
From 1 Division of Thoracic Surgery, Department of Surgery and 2 Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo,Japan Received February 10, 2009; accepted for publication July 17, 2009 Address reprint requests to Shuji Haraguchi, MD: Department of Surgery, Nippon Medical School, 1–1–5 Sendagi, Bunkyo-ku, Tokyo, 113–8603, Japan. ©2010 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.

because of early detection and curative resection of the first cancer, andrecently many articles have been reported in this regard.1–13) Metachronous NSCLC still has controversial problems, especially in the criteria for diagnosis and treatment. Occasionally, differentiating it from local recurrence or pulmonary metastasis is very difficult if the first and second cancers have the same histology. Surgery in the bilateral thoraces or completion pneumonectomy is quite riskyin compromised hosts. In the present study, we report mortality and analyze prognostic factors for overall survival in patients with metachronous NSCLC in our institution.

Ann Thorac Cardiovasc Surg Vol. 16, No. 5 (2010)

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Haraguchi et al.

Material and Methods
From July 1982 to July 2008, a total of 1726 patients with lung cancer underwent lung resection at the Division ofThoracic Surgery, Department of Surgery, Nippon Medical School, and the Department of Surgery, Nippon Medical School Musashikosugi Hospital. The definition of metachronous lung cancer was according to Martini and Melamed1) and described as follows: (A) different histology, and (B) same histology if (1) the free interval between cancers was at least 2 years, or (2) if the origin was from carcinoma in...