Pretreatment Clinical Mediastinal Nodal Bulk and Extent do not Influence Survival in N2-Positive Stage IIIA Non-small Cell Lung Cancer Patients Treated with Trimodality Therapy

详细信息    查看全文

• 作者：Hyebin Lee MD (1)
  Yong Chan Ahn MD ; PhD (1)
  Hongryull Pyo MD ; PhD (1)
  BoKyong Kim MD ; PhD (1)
  Dongryul Oh MD (1)
  Heerim Nam MD (2)
  Eunju Lee MD (1)
  Jong-Mu Sun MD ; PhD (3)
  Jin Seok Ahn MD ; PhD (3)
  Myung-Ju Ahn MD ; PhD (3)
  Keunchil Park MD ; PhD (3)
  Yong Soo Choi MD ; PhD (4)
  Jhingook Kim MD ; PhD (4)
  Jae Ill Zo MD ; PhD (4)
  Young Mog Shim MD ; PhD (4)
  
• 关键词：Stage IIIA ; Non ; small cell lung cancer ; Trimodality therapy ; Prognostic factor ; Lymph node
• 刊名：Annals of Surgical Oncology
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：21
• 期：6
• 页码：2083-2090
• 全文大小：
• 参考文献：1. Martini N, Flehinger BJ, Zaman MB, Beattie EJ Jr. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases. / Ann Surg. 1983;198:386-97. CrossRef
  2. Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. / J Natl Cancer Inst. 1994;86:673-80. CrossRef
  3. Dillman RO, Seagren SL, Propert KJ, et al. A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. / N Engl J Med. 1990;323:940-45. CrossRef
  4. Perez CA, Pajak TF, Rubin P, et al. Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy. Report by the Radiation Therapy Oncology Group. / Cancer. 1987;59:1874-881. CrossRef
  5. Martini N, Kris MG, Ginsberg RJ. The role of multimodality therapy in locoregional non-small cell lung cancer. / Surg Oncol Clin N Am. 1997;6:769-91.
  6. Curran WJ Jr, Paulus R, Langer CJ, et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. / J Natl Cancer Inst. 2011;103:1452-460. CrossRef
  7. Fournel P, Robinet G, Thomas P, et al. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d’Oncologie Thoracique-Groupe Francais de Pneumo-Cancerologie NPC 95-01 Study. / J Clin Oncol. 2005;23:5910-917. CrossRef
  8. Pass HI, Pogrebniak HW, Steinberg SM, et al. Randomized trial of neoadjuvant therapy for lung cancer: interim analysis. / Ann Thorac Surg. 1992;53:992-98. CrossRef
  9. Scagliotti GV, Pastorino U, Vansteenkiste JF, et al. Randomized phase III study of surgery alone or surgery plus preoperative cisplatin and gemcitabine in stages IB to IIIA non-small-cell lung cancer. / J Clin Oncol. 2012;30:172-78. CrossRef
  10. Albain KS, Rusch VW, Crowley JJ, et al. Concurrent cisplatin/etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small-cell lung cancer: mature results of Southwest Oncology Group phase II study 8805. / J Clin Oncol. 1995;13:1880-892.
  11. Choi NC, Carey RW, Daly W, et al. Potential impact on survival of improved tumor downstaging and resection rate by preoperative twice-daily radiation and concurrent chemotherapy in stage IIIA non-small-cell lung cancer. / J Clin Oncol. 1997;15:712-22.
  12. Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. / Lancet. 2009;374:379-86. CrossRef
  13. Shah AA, Berry MF, Tzao C, et al. Induction chemoradiation is not superior to induction chemotherapy alone in stage IIIA lung cancer. / Ann Thorac Surg. 2012;93:1807-812. CrossRef
  14. Toyooka S, Kiura K, Shien K, et al. Induction chemoradiotherapy is superior to induction chemotherapy for the survival of non-small-cell lung cancer patients with pathological mediastinal lymph node metastasis. / Interact Cardiovasc Thorac Surg. 2012;15:954-60. CrossRef
  15. Ahn YC, Park K, Kim DY, et al. Preoperative concurrent chemoradiotherapy for stage IIIA non-small cell lung cancer. / Acta Oncol. 2001;40:588-92. CrossRef
  16. Kang MK, Ahn YC, Lim DH, et al. Preoperative concurrent radiochemotherapy and surgery for stage IIIA non-small cell lung cancer. / J Korean Med Sci. 2006;21:229-35. CrossRef
  17. Kim KJ, Ahn YC, Lim do H, et al. (2007) Analyses on prognostic factors following tri-modality therapy for stage IIIa non-small cell lung cancer. / Lung Cancer. 55:329-36. CrossRef
  18. NCCN guidelines version 2. 2013. Non-small cell lung cancer. Available from http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. 2013.
  19. Machtay M, Lee JH, Stevenson JP, et al. Two commonly used neoadjuvant chemoradiotherapy regimens for locally advanced stage III non-small cell lung carcinoma: long-term results and associations with pathologic response. / J Thorac Cardiovasc Surg. 2004;127:108-13. CrossRef
  20. Pourel N, Santelmo N, Naafa N, et al. Concurrent cisplatin/etoposide plus 3D-conformal radiotherapy followed by surgery for stage IIB (superior sulcus T3N0)/III non-small cell lung cancer yields a high rate of pathological complete response. / Eur J Cardiothorac Surg. 2008;33:829-36. CrossRef
  21. D’Angelillo RM, Trodella L, Ciresa M, et al. Multimodality treatment of stage III non-small cell lung cancer: analysis of a phase II trial using preoperative cisplatin and gemcitabine with concurrent radiotherapy. / J Thorac Oncol. 2009;4:1517-523. CrossRef
  22. Andre F, Grunenwald D, Pignon JP, et al. Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications. / J Clin Oncol. 2000;18:2981-989.
  23. Tanner NT, Gomez M, Rainwater C, et al. Physician preferences for management of patients with stage IIIA NSCLC: impact of bulk of nodal disease on therapy selection. / J Thorac Oncol. 2012;7:365-69. CrossRef
  
• 作者单位：Hyebin Lee MD (1)
  Yong Chan Ahn MD, PhD (1)
  Hongryull Pyo MD, PhD (1)
  BoKyong Kim MD, PhD (1)
  Dongryul Oh MD (1)
  Heerim Nam MD (2)
  Eunju Lee MD (1)
  Jong-Mu Sun MD, PhD (3)
  Jin Seok Ahn MD, PhD (3)
  Myung-Ju Ahn MD, PhD (3)
  Keunchil Park MD, PhD (3)
  Yong Soo Choi MD, PhD (4)
  Jhingook Kim MD, PhD (4)
  Jae Ill Zo MD, PhD (4)
  Young Mog Shim MD, PhD (4)
  
  1. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  2. Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  3. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  4. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  
• ISSN：1534-4681

文摘

Background Treatment for patients with N2-positive stage IIIA non-small cell lung cancer has been a controversial issue. The current study evaluated the outcomes in patients treated with trimodality therapy, which consisted of neoadjuvant radiation therapy concurrent with chemotherapy followed by surgical resection, with emphasis on clinical and pathologic nodal status. Methods We reviewed the records of 355 patients who were treated with trimodality therapy between 1997 and 2011. Results After completion of neoadjuvant chemoradiation, overall down-staging and complete response rates were 50.4?% (179 patients), and 13.2?% (47 patients), respectively. With median follow-up of 35.3?months, median times of progression-free survival (PFS) and overall survival (OS) were 16.3?months and 45.5?months, respectively. Seventeen patients (4.8?%) died of postoperative complications, and the remaining 338 patients were analyzed on prognostic factors. Old age (p?=?0.032), pneumonectomy (p?<?0.001), and ypN+ (p?<?0.001) were found to be the significant prognosticators for worse PFS, and old age (p?=?0.013), pneumonectomy (p?<?0.001), and ypN+ (p?<?0.001) were related to worse OS. Clinical N2 status did not influence either OS or PFS: the number of involved stations (single station vs. multi-station; p?=?0.187 for PFS; p?=?0.492 for OS), and bulk (clinically evident vs. microscopic; p?=?0.902 for PFS; p?=?0.915 for OS). Conclusion ypN stage was the most important prognosticator for both PFS and OS; however, neither initial bulk nor extent of cN2 disease influenced prognosis. Surgery following neoadjuvant chemoradiation should have contributed to improved clinical outcomes regardless of clinical nodal bulk and extent.