Prognostic factors and long term results of neo adjuvant therapy followed by surgery in stage IIIA N2 non-small cell lung cancer patients

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Date: October-December 2009
From: Annals of Thoracic Medicine(Vol. 4, Issue 4)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Clinical report
Length: 4,737 words

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Byline: Jing. Li, Chun-Hua. Dai, Shun-Bing. Shi, Ping. Chen, Li-Chao. Yu, Jian-Rong. Wu

Background: Prognosis of stage IIIA[sub] N2[sub] non-small cell lung cancer (NSCLC) remains poor despite the changes in therapeutic strategies. Objectives: To assess long term results of neo adjuvant therapy followed by surgery for patients with stage IIIA N2 NSCLC and to analyze factors influencing survival. Materials and Methods: The methods adopted include: Retrospective review of medical records of 91 patients with stage IIIA N2 NSCLC, who received neo adjuvant therapy followed by surgery; collection of information on demographic information, staging procedure, preoperative therapy, clinical response, type of resection, pathologic response of tumor, status of lymph nodes and adjuvant chemotherapy; survival analysis by Kaplan-Meier and calculation of prognostic factors using log-rank and Cox regression model. Results: All patients received a platinum-based chemotherapy and 23 (29.1%) had an associated radiotherapy. Eighty four patients underwent thoracotomy. Median survival was 26 months (95%CI, 22.6-30.8 months) with three and five year survival rates of 31.6 and 20.9%, respectively. Prognostic factors for survival on univariate analysis was clinical response ( P = 0.032), complete resection ( P = 0.002), pathologic tumor response ( P < 0.001), and lymph nodal down staging ( P = 0.001). Multivariate analyses identified complete resection, pathologic tumor response and lymph nodal down staging as independent prognostic factors. Conclusion: Survival of patients with stage IIIA N2 NSCLC who received neo adjuvant therapy is significantly influenced by clinical response, complete resection, pathologic tumor response, and lymph nodal down staging. These results can be helpful in guiding standard clinical practice and evaluating the outcome of neo adjuvant therapy followed by surgery in patients with stage IIIA N2 NSCLC.

Stage IIIA N2 non-small cell lung cancer (NSCLC) with involvement of ipsilateral mediastinal N2 represents a heterogeneous group of patients. For patients with this locally advanced disease, five-year survival rate after surgery or radiotherapy alone is only approximately 10%; majority of the patients died of distant metastases.[sup] [1],[2] This observation led to attempts to improve survival by adopting combined modality approaches such as neo adjuvant chemotherapy followed by surgery and/or radiotherapy. The rationale for using neo adjuvant chemotherapy for the treatment of stage IIIA NSCLC is based on evidence that chemotherapy can reduce tumor burden which could facilitate surgery, improve resectability and eradicate micrometastases to prevent systemic relapse.[sup] [3],[4] Several phase II trials show the role of neo adjuvant chemotherapy in patients with locally advanced NSCLC. [sup] [5],[6],[7] Two small randomized trials suggest a prolonged survival for neo adjuvant chemotherapy followed by surgery compared with surgery alone for stage IIIA NSCLC. [sup] [8],[9],[10],[11] However, a phase III randomized trial reported by Nagai et al . failed to demonstrate any benefit of neo adjuvant chemotherapy followed by surgery over surgery alone.[sup] [12] In another phase III trial in resectable stages I (except T1 N0), II and IIIA NSCLC patients, neo adjuvant chemotherapy failed to improve survival of stage IIIA N2 patients.[sup] [13] Inconsistency of results from randomized trials assessing neo adjuvant chemotherapy for stage...

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Gale Document Number: GALE|A209064816