Prognostic factors of resected lung cancer with chest wall involvement

Antonio Mazzella, Mauro Loi, Marco Alifano

Abstract

Chest wall involvement in bronchogenic carcinomas is observed approximately 5% to 8% of resectable lung cancer. These carcinomas are classified as T3 or T4 depending on the structures involved, but in such cases, extended resection is needed to maximize the chances of durable disease control. Surgical resection, whose technical feasibility was firstly described in 1947, is the key element in the management of these patients and the effective role of multimodality regimens or the part of adjuvant chemotherapy or radiotherapy in the R0-chest wall invading NSCLC without nodal involvement is the argument of debate. Regardless of pT or pN, overall 5-years survival for these patients ranges from 10% to 61.4% in the different series. However, the prognosis of these patients depends on several factors. Different prognostic factors have been consistently reported in the literature for those patients. The most important are the presence of nodal involvement, with the worst prognosis in N1 et N2, incomplete resection of the tumor and pathological R1 or R2 disease, depth of chest wall infiltration and extension of resection. Age and female sex are other reported factors. Even if multimodality management encompassing chemotherapy and radiotherapy strategies in lung cancer invading chest wall is debated, a multidisciplinary approach, integrating surgery, neoadjuvant and adjuvant radio, and chemotherapy is the key to offer patients the best available solutions in the optimal timing.