A comparison of survival and disease-specific survival in surgically resected, lymph node-positive bronchioloalveolar carcinoma versus nonsmall cell lung cancer: implications for adjuvant therapy.
BACKGROUND
The objective of this study was to assess whether disease-specific survival (DSS) and overall survival (OS) differed among patients who had N1 and N2 bronchioloalveolar carcinoma (BAC) compared with patients who had non-BAC nonsmall cell lung cancer (NSCLC).


METHODS
The Surveillance, Epidemiology, and End Results (SEER) Program database from 1992 to 2002 contained 684 patients with BAC and 9809 patients with non-BAC NSCLC who had N1/N2 tumors and who underwent a definitive surgical procedure. OS and DSS rates were compared according to potential prognostic factors, including the use of a matched-pair analysis.


RESULTS
The BAC patients with either pathologic N1 or N2 lymph node status were significantly more likely to be women, and nonblack/nonwhite race, but significantly less likely to have poorly differentiated or undifferentiated tumors than patients with non-BAC cancers with comparable lymph node status. The median follow-up of all patients was 29 months. There was a significant difference in DSS between patients with N2 BAC and non-BAC cancers, but not for patients with N1 disease. There was a nonsignificant trend toward longer OS for patients with N2 BAC compared with non-BAC cancers.


CONCLUSIONS
Patients with lymph node-positive BAC had distinctly different patient and tumor characteristics than patients with lymph node-positive non-BAC NSCLC. Because DSS appears to be better for patients with N2 BAC, they may not benefit as much from adjuvant therapy as patients with non-BAC NSCLC.
Varlotto
John M
JM
Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. jvarlotto@hmc.psu.edu
Flickinger
John C
JC
Recht
Abram
A
Nikolov
Margaret C
MC
DeCamp
Malcolm M
MM
D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate