Objective: To study the impact of TNM stage and various preoperative functional parameters on survival in patients who underwent lobectomy for non-small cell lung cancer (NSCLC) in Iceland from 1999 to 2008.

Materials and methods: Retrospective study including 213 patients (mean age 66.9 yrs, equal male/female ratio) that underwent lobectomy for NSCLC. Tumors were staged by the TNM staging system, survival was estimated by the Kaplan-Meier method and prognostic factors of survival studied using the Cox proportional hazards regression model.

Results:Survival at 1 year was 82.7% and 45.1% at 5 years. Operative mortality at 30 days was 0%. Most tumors were found to be in stage I (59.6%) or stage II (17.8%) and 7% were stage IIIA, whereas 14.6% were in stage IIIB or IV. Using multivariate analysis; advancing stage, increasing tumor size, reduced lung function and history of arrhythmia, predicted worse survival, whereas adenocarcinoma histology was a positive prognostic factor (HR 0.5, p=0.002) when compared to other histological types.

Conclusions: Survival for patients undergoing lobectomy for operable non-small cell lung cancer in Iceland is comparable with other studies. Advanced stage, tumor size, reduced lung function and arrhythmia were negative predictors of survival, but in contrast to many but not all studies adenocarcinoma histology predicted a better prognosis compared to other tumor types.

Figure 1:
Grade of 210 primary NSCLC tumors resected by lobectomy in Iceland 1999 – 2008. Three tumors were not gradeable and therefore excluded.

Figure 2a-d:
Survival of 213 patients with NSCLC in different subgroups, in Iceland 1999– 2008. Dotted lines show 95% CI limits and log-rank test was used to compare groups. Fig. 2a shows overall survival for the whole group of patients. Five year survival was 45.1%. Fig. 2b shows survival for different stages, survival for stages I-III being 61.8%, 21.3% and 20.5%, respectively. Survival between stages I and II-III was highly significant, but not between stages II and III (p=0.078). Fig. 2c shows survival based on tumor size. There was significant difference between smaller and larger than 3 cm sized tumors, with 55.2%  vs. 37.6% five year survival, respectively (p=0.002). Fig. 2d shows survival based on adeno- (n=132) and squamous cell carcinoma histology (n=62), with 48.6% and 35.3% five year survival, respectively  (p=0,02). Other histology was excluded (n=19).

Table I:
Stage of 213 primary NSCLC tumors resected by lobectomy in Iceland 1999-2008.