Published in:
01-06-2019 | Research Article
Prognostic factors in neoadjuvant treatment followed by surgery in stage IIIA-N2 non-small cell lung cancer: a multi-institutional study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society)
Authors:
F. Couñago, S. Montemuiño, M. Martin, B. Taboada, P. Calvo-Crespo, M. P. Samper-Ots, P. Alcántara, J. Corona, J. L. López-Guerra, M. Murcia-Mejía, M. López-Mata, J. Jové-Teixidó, M. Chust, V. Díaz-Díaz, L. de Ingunza-Barón, T. García-Cañibano, M. L. Couselo, E. del Cerro, J. Moradiellos, S. Amor, A. Varela, M. M. Puertas, I. J. Thuissard, D. Sanz-Rosa, N. R. de Dios
Published in:
Clinical and Translational Oncology
|
Issue 6/2019
Login to get access
Abstract
Purpose
To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC).
Methods
A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method and compared using the log-rank test. Cox regression analysis was performed.
Results
Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5 months (5–128 months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0–pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen.
Conclusions
In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patients.