Comparative prognostic features of stage IIIAN2 and IIIB non-small-cell lung cancer patients treated with surgery after induction therapy.
OBJECTIVE
Induction Therapy (IT) before surgery emerged as a widely used strategy for IIIAN2 and selected IIIB NSCLC patients. However, IT is associated with a possible increase in postoperative complications. Consequently, selection of patients with the best chances to benefit from combined treatment is mandatory.


METHODS
Study recorded demographics, treatment and outcome of consecutive patients treated with IT plus surgery for IIIAN2 or IIIB NSCLC. Survival was analysed by Kaplan-Meier and prognostic factors were analysed by log-rank and Cox regression.


RESULTS
From 1993 to 2003, 155 patients (IIIAN2=95/IIIB=60) were treated. Complete resection was associated with a significant prolonged median survival both for IIIAN2 (20 vs 16 months, P=0.05) and IIIB (20 vs 15 months, P=0.02) patients. A lower risk of death for IIIAN2 patients was independently associated with postoperative mediastinal lymph node clearance (HR=0.45, 95%CI [0.25-0.81], P=0.009) and absence of postoperative complication (HR=0.54, 95%CI [0.31-0.93], P=0.02). Absence of blood vessel invasion only was identified as an independent predictor of a lower risk of death (HR=0.27, 95%CI [0.12-0.59], P=0.01) for stage IIIB patients.


CONCLUSIONS
Besides similarities as the role of a complete R0 resection, treatment-related factors influence outcome of IIIAN2 patients while disease-related factors prevail on survival of IIIB patients, in whom the benefit of IT is unclear.
Barlési
Fabrice
F
Department of Thoracic Oncology, Faculty of Medicine-Assistance Publique Hôpitaux de Marseille, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France. fabrice.barlesi@mail.ap-hm.fr
Doddoli
Christophe
C
Torre
Jean-Philippe
JP
Giudicelli
Roger
R
Fuentes
Pierre
P
Thomas
Pascal
P
Astoul
Philippe
P
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008198:Lymph Nodes / Q000601:surgery; D008297:Male; D008482:Mediastinum / Q000601:surgery; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012074:Remission Induction; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents