title: Histopathologic response criteria predict survival of patients with resected lung cancer after neoadjuvant chemotherapy.
abstract: BACKGROUND
  We evaluated the ability of histopathologic response criteria to predict overall survival (OS) and disease-free survival (DFS) in patients with surgically resected non-small cell lung cancer (NSCLC) treated with or without neoadjuvant chemotherapy.
  
  
  METHODS
  Tissue specimens from 358 patients with NSCLC were evaluated by pathologists blinded to the patient treatment and outcome. The surgical specimens were reviewed for various histopathologic features in the tumor including percentage of residual viable tumor cells, necrosis, and fibrosis. The relationship between the histopathologic findings and OS was assessed.
  
  
  RESULTS
  The percentage of residual viable tumor cells and surgical pathologic stage were associated with OS and DFS in 192 patients with NSCLC receiving neoadjuvant chemotherapy in multivariate analysis (p = 0.005 and p = 0.01, respectively). There was no association of OS or DFS with percentage of viable tumor cells in 166 patients with NSCLC who did not receive neoadjuvant chemotherapy (p = 0.31 and p = 0.45, respectively). Long-term OS and DFS were significantly prolonged in patients who had ≤10% viable tumor compared with patients with >10% viable tumor cells (5 years OS, 85% versus 40%, p < 0.0001 and 5 years DFS, 78% versus 35%, p < 0.001).
  
  
  CONCLUSIONS
  The percentages of residual viable tumor cells predict OS and DFS in patients with resected NSCLC after neoadjuvant chemotherapy even when controlled for pathologic stage. Histopathologic assessment of resected specimens after neoadjuvant chemotherapy could potentially have a role in addition to pathologic stage in assessing prognosis, chemotherapy response, and the need for additional adjuvant therapies.
authors.affiliation: Departments of Thoracic and Cardiovascular Surgery, the University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. apataer@mdanderson.org
authors.forename: Apar
authors.initials: A
authors.lastname: Pataer
authors.forename: Neda
authors.initials: N
authors.lastname: Kalhor
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Maria Gabriela
authors.initials: MG
authors.lastname: Raso
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Erasmus
authors.forename: Edward S
authors.initials: ES
authors.lastname: Kim
authors.forename: Carmen
authors.initials: C
authors.lastname: Behrens
authors.forename: J Jack
authors.initials: JJ
authors.lastname: Lee
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: David J
authors.initials: DJ
authors.lastname: Stewart
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Ignacio I
authors.initials: II
authors.lastname: Wistuba
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D015996:Survival Rate; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D005047:Etoposide; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D000093542:Gemcitabine