title: Late stage (III and IV) non-small cell cancer of the lung: results of surgical resection at Inova Fairfax Hospital.
abstract: One hundred forty-two patients underwent surgery and related treatment for advanced stage (III, IV) non-small cell cancer of the lung. One hundred seventeen patients underwent up-front surgery, with a hospital mortality rate of 1.7% (2/117). Kaplan-Meier 5-year survival in this group was 31% (+/- 5). Twenty-five patients underwent neoadjuvant therapy followed by surgical resection, with respective rates of hospital mortality, complete pathologic response, and major pathologic response of 0%, 16%, and 64%. Kaplan-Meier 5-year survival in this latter group was 34% (+/- 11). Of the 16 patients undergoing neoadjuvant therapy who had complete pathologic response or significant downstaging from stage III disease, Kaplan-Meier 5-year survival was 61% (+/- 15). Three clinical observations of interest emerged regarding survival. First, in those patients with postresection FEV1 < 1.0 L, hospital mortality rate was 20%, and there were no 5-year survivors (P < 0.0001). Second, where neoadjuvant therapy was associated with complete pathologic response or significant downstaging of disease, there was a trend for improved survival in the downstaged group, but it did not reach statistical significance (P = 0.14). Third, adjuvant therapy was associated with improved 5-year survival (P = 0.03), particularly for combination chemotherapy and radiotherapy (P = 0.02).
authors.affiliation: Section of Thoracic Surgery, Inova Fairfax Hospital, c/o Suite 301, 3301 Woodbum Road, Annandale, VA 22003, USA. pdkkiernan@aol.com
authors.forename: Paul D
authors.initials: PD
authors.lastname: Kiernan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sheridan
authors.forename: James
authors.initials: J
authors.lastname: Lamberti
authors.forename: Thomas
authors.initials: T
authors.lastname: LoRusso
authors.forename: Vivian
authors.initials: V
authors.lastname: Hetrick
authors.forename: Betty
authors.initials: B
authors.lastname: Vaughan
authors.forename: Paula
authors.initials: P
authors.lastname: Graling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D015996:Survival Rate