title: The evolution of treatment outcomes for resected stage IIIA non-small cell lung cancer over 16 years at a single institution.
abstract: OBJECTIVE
  The effect of multimodality treatment including surgical intervention, chemotherapy, and radiation for potentially resectable stage IIIA non-small cell lung cancer in a practice setting remains to be defined. To determine which treatment factors are associated with improved survival, we evaluated outcomes for these patients at our institution over a 16-year period.
  
  
  METHODS
  We surveyed our institutional pathology database from 1986 through 2001 for patients with resected pathologic stage IIIA (N2) non-small cell lung cancer. Three hundred fifty-three patients were confirmed to have appropriate pathologic staging and attempted complete resection. These patients were assessed by means of univariate and multivariable analysis for factors associated with long-term survival. Stage migration was estimated by using a classification based on nodal station involvement.
  
  
  RESULTS
  Median potential follow-up was 132 months. During the study period, 3- and 5-year survival increased; preoperative staging improved, relatively more lobectomies and fewer pneumonectomies were performed, and multimodality treatment was used more frequently. The number of positive N2 nodal stations did not change over time (P = .14). Surgical intervention alone resulted in 3-year survival of 30%, and perioperative chemotherapy, radiation, or both increased 3-year survival to 38% (P = .004). Multivariable analysis showed that male sex (hazard ratio, 1.44; 95% confidence interval, 1.13-1.84; P = .003), more than 2 positive mediastinal nodal stations (hazard ratio, 1.73; 95% confidence interval, 1.16-2.57; P = .007), R1 or R2 resection (hazard ratio, 1.72; 95% confidence interval, 1.22-2.41; P = .002), lower or middle lobe tumor location (hazard ratio, 1.63; 95% confidence interval, 1.28-2.08; P < .001), and surgical intervention alone (hazard ratio, 1.59; 95% confidence interval, 1.23-2.04; P < .001) were independent predictors of poor survival.
  
  
  CONCLUSIONS
  The use of multimodality therapy appears to contribute to improved outcomes over time in patients with resected stage IIIA (N2) non-small cell lung cancer.
authors.affiliation: Departments of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex, USA.
authors.forename: Linda W
authors.initials: LW
authors.lastname: Martin
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Wayne
authors.initials: W
authors.lastname: Hofstetter
authors.forename: Waun Ki
authors.initials: WK
authors.lastname: Hong
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: W Roy
authors.initials: WR
authors.lastname: Smythe
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome