Predictors for locoregional recurrence for clinical stage III-N2 non-small cell lung cancer with nodal downstaging after induction chemotherapy and surgery Journal Article
| Authors: | Amini, A.; Lou, F.; Correa, A. M.; Baldassarre, R.; Rimner, A.; Huang, J.; Roth, J. A.; Swisher, S. G.; Vaporciyan, A. A.; Lin, S. H. |
| Article Title: | Predictors for locoregional recurrence for clinical stage III-N2 non-small cell lung cancer with nodal downstaging after induction chemotherapy and surgery |
| Abstract: | Purpose: Pathologic downstaging following chemotherapy for stage III-N2 NSCLC is a well-known positive prognostic indicator. However, the predictive factors for locoregional recurrence (LRR) in these patients are largely unknown. Methods: Between 1998 and 2008, 153 patients with clinically or pathologically staged III-N2 NSCLC from two cancer centers in the United States were treated with induction chemotherapy and surgery. All had pathologic N0-1 disease, and none received postoperative radiotherapy. LRR were defined as recurrence at the surgical site, lymph nodes (levels 1-14 including supraclavicular), or both. Results: Median follow-up was 39.3 months. Pretreatment N2 status was confirmed pathologically (18.2 %) or by PET/CT (81.8 %). Overall, the 5-year LRR rate was 30.8 % (n = 38), with LRR being the first site of failure in 51 % (22/+99877943). Five-year overall survival for patients with LRR compared with those without was 21 versus 60.1 % (p < 0.001). Using multivariate analysis, significant predictors for LRR were pN1 disease at time of surgery (p < 0.001, HR 3.43, 95 % CI 1.80-6.56) and a trend for squamous histology (p = 0.072, HR 1.93, 95 % CI 0.94-3.98). Five-year LRR rate for pN1 versus pN0 disease was 62 versus 20 %. Neither single versus multistation N2 disease (p = 0.291) nor initial staging technique (p = 0.306) were predictors for LRR. N1 status also was predictive for higher distant recurrence (p = 0.021, HR 1.91, 95 % CI 1.1-3.3) but only trended for poorer survival (p = 0.123, HR 1.48, 95 % CI 0.9-2.44). Conclusions: LRR remains high in resected stage III-N2 NSCLC patients after induction chemotherapy and nodal downstaging, particularly in patients with persistent N1 disease. © 2012 The Author(s). |
| Keywords: | adult; cancer chemotherapy; cancer survival; treatment response; aged; cancer surgery; major clinical study; overall survival; histopathology; cancer recurrence; postoperative period; united states; cancer staging; follow up; lymph node metastasis; antineoplastic agent; lung non small cell cancer; cancer center; predictor variable; induction chemotherapy |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 20 |
| Issue: | 6 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2013-06-01 |
| Start Page: | 1934 |
| End Page: | 1940 |
| Language: | English |
| DOI: | 10.1245/s10434-012-2800-x |
| PROVIDER: | scopus |
| PMCID: | PMC3656229 |
| PUBMED: | 23263700 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 July 2013" - "CODEN: ASONF" - "Source: Scopus" |
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