Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935.
OBJECTIVE
CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung cancer. Induction cisplatin/vinblastine chemotherapy was followed by surgical resection, adjuvant cisplatin/vinblastine, and radiotherapy. We now evaluate the prognosis of pathologic nodes.


METHODS
Failure-free survival was calculated from a landmark 3 months after resection to account for heterogeneity in adjuvant therapy.


RESULTS
Nine of 42 (21%) resected patients had no residual N2 disease. This subset of 9 had a median failure-free interval of 47.8 months from landmark, whereas the 33 patients (79%) with persistent N2 disease had a median failure-free survival of 8.2 months from landmark (P=0.01). Although 21/42 (50%) had an incomplete resection (positive highest resected node and/or margin), completeness of resection did not influence failure-free survival. There were 3 distant and no local recurrences among the N2 negative group, and 12 local recurrences among patients with residual N2 disease (P=0.041).


CONCLUSIONS
These data suggest: (1) persistent N2 disease following induction chemotherapy is unfavorable; (2) patients downstaged to N2 negative may benefit from surgical resection; however, (3) 33% of N2 negative patients suffered disease relapse.
Jaklitsch
Michael T
MT
Division of Thoracic Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. mjaklitsch@partners.org
Herndon
James E
JE
DeCamp
Malcolm M
MM
Richards
William G
WG
Kumar
Parvesh
P
Krasna
Mark J
MJ
Green
Mark R
MR
Sugarbaker
David J
DJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D008482:Mediastinum / Q000473:pathology; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D014747:Vinblastine / Q000008:administration & dosage
D014747:Vinblastine; D002945:Cisplatin