Outcome of Patients With pN2 “Potentially Resectable” Nonsmall Cell Lung Cancer Who Underwent Surgery After Induction Chemotherapy

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• 作者：Lorenzo Spaggiari ; MD ; PhD^* ; ^&dagger ; ; ¹ ; Monica Casiraghi ; MD^* ; ¹ ; ^{monica.casiraghi@ieo.it} ; Juliana Guarize ; MD^* ; Daniela Brambilla ; MSc^* ; Francesco Petrella ; MD^* ; Patrick Maisonneuve ; Eng^&Dagger ; ; Filippo De Marinis ; MD^§ ;
• 关键词：Non small cell lung cancer ; induction chemotherapy ; lymph nodes involvemnt ; stage IIIA
• 刊名：Seminars in Thoracic and Cardiovascular Surgery
• 出版年：2016
• 出版时间：Summer 2016
• 年：2016
• 卷：28
• 期：2
• 页码：593-602
• 全文大小：843 K
• 卷排序：28

文摘

Patients with stage IIIA-ipsilateral mediastinal lymph node involvement (N2) non–small cell lung cancer (NSCLC) represent a heterogeneous group with different clinical presentation. The aim of this study was to analyze a series of patients with “potentially resectable” stage IIIA-pathologically proven N2 (pN2) NSCLC undergoing induction chemotherapy followed by surgery to evaluate their long-term outcomes and to identify prognostic factors. Out of 287 patients who underwent induction chemotherapy for NSCLC with ipsilateral mediastinal lymph node involvement pathologically proven, we retrospectively evaluated 141 (49%) patients with no clinical evidence of progression after induction chemotherapy and candidates for surgery. Most of them (73%) underwent at least 3 cycles of cisplatin-based chemotherapy. We used the Kaplan-Meier method to plot survival and the log-rank test to assess the survival difference between groups. Multivariable analysis was performed using Cox proportional hazards regression. A total of 15 (10.6%) patients underwent explorative thoracotomy; 126 patients underwent surgical anatomical resection after a median 27 days (range: 21-30) from the last cycle of chemotherapy. A total of 113 (89.7%) patients had a radical resection. A total of 22 (17.5%) patients had a complete pathologic lymph node downstaging (pN0), and 8 (6.3%) patients had a complete pathological response (pT0N0). The median overall survival was 24 months, with a 5-year overall survival of 30%. At multivariable analysis, downstaging and number of cycles of chemotherapy were independent prognostic factors (P = 0.006); downstaging benefit was mostly because of complete pathological response (hazards ratio = 0.23, 95% CI: 0.07-0.76). In conclusion, more than 3 cycles of chemotherapy and pathological downstaging could significantly improve 5-year survival in selected patients with “potentially resectable” pathologically proven N2 disease.