Elsevier

The Annals of Thoracic Surgery

Volume 70, Issue 6, December 2000, Pages 1826-1831
The Annals of Thoracic Surgery

Original article: general thoracic
Nodal stage after induction therapy for stage IIIA lung cancer determines patient survival

Presented at the Poster Session of the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.
https://doi.org/10.1016/S0003-4975(00)01585-XGet rights and content

Abstract

Background. This study was undertaken to determine the predictive value of nodal status at resection in regards to long-term outcome of patients undergoing neo-adjuvant therapy and resection for stage IIIA N2-positive non-small cell lung cancer (NSCLC).

Methods. We reviewed the medical records of all patients found on surgical staging to have N2-positive NSCLC and who underwent induction therapy followed by resection between 1988 and 1996 at our hospital. Complete follow-up information was examined utilizing Kaplan-Meier survival analysis and Cox proportional hazards multivariate analysis.

Results. One hundred three patients (59 men) with stage IIIA N2-positive NSCLC received neoadjuvant therapy before surgical resection. Preoperative therapy consisted of platinum-based chemotherapy (76), radiotherapy (18), or chemoradiation (9). Operations included pneumonectomy (38), bilobectomy (6), and lobectomy (59). There were four deaths and seven major complications. Eighty-five patients were followed until death. Median survival among 18 living patients is 60.9 months (range 29 to 121 months). Twenty-nine patients were downstaged to N0 and had 5-year survival of 35.8% (median survival 21.3 months). Seventy-four patients with persistent tumor in their lymph nodes (25 N1 and 49 N2) had significantly worse, 9%, 5-year survival, p = 0.023 (median survival 15.9 months). Other negative prognostic factors were adenocarcinoma and pneumonectomy.

Conclusions. Patients with N2-positive NSCLC whose nodal disease is eradicated after neoadjuvant therapy and surgery enjoy significantly improved cancer-free survival. These data support surgical resection for patients downstaged by induction therapy; however, patients who are not downstaged do not benefit from surgical resection. Direct effort should be made to improve the accuracy of restaging before resection.

Section snippets

Patients and methods

To identify all patients with stage IIIA NSCLC, a retrospective chart review was conducted on patients operated upon by members of the Division of Thoracic Surgery at Brigham and Women’s Hospital. A major question addressed in this study concerns the relevance of nodal status after induction therapy to patient prognosis after surgery. To answer this question, we limited our analysis only to patients who had been surgically staged as IIIA, underwent induction therapy followed by complete

Results

There were 44 women and 59 men in the group. The median age was 59 years (range 37 to 82 years). Twenty-nine patients were discovered to have lung cancer on a routine or a preoperative chest radiograph. Twenty-three patients presented with a cough, and 17 patients presented with hemoptysis. The rest of the patients presented with a variety of complaints including dyspnea, malaise, weight-loss, fever, pneumonia, and chest pain. Most patients were current or former smokers; however, 8 patients

Comment

In our retrospective review, we examined the outcome of a large number of patients who presented with N2-positive stage IIIA NSCLC and were treated with induction therapy followed by surgical resection. In this analysis, we focused only on completely resected patients because that was the only group for which complete pathological data are available. Unlike the patients in other series, all our patients were surgically staged with mediastinoscopy and biopsy of multiple nodal stations. All

Acknowledgements

We thank Elizabeth Allred for statistical analysis and Mary Visciano for editorial assistance.

References (16)

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