title: Now or later: evaluating the importance of chemotherapy timing in resectable stage III (N2) lung cancer in the National Cancer Database.
abstract: BACKGROUND
  Preoperative chemotherapy improves the survival of surgically managed stage III non-small cell lung cancer (NSCLC). A proportion of stage III NSCLC patients in the United States have undergone operations primarily and been given chemotherapy postoperatively. It is unclear whether postoperative chemotherapy is as effective as preoperative chemotherapy. Our objective was to determine the survival of resected stage III NSCLC according to the timing of chemotherapy.
  
  
  METHODS
  The National Cancer Database (NCDB) was queried for clinical T1-4N2M0 NSCLC (cstage III-cN2) undergoing lobectomy or pneumonectomy between 2003 and 2006.
  
  
  RESULTS
  1,356 patients with surgically managed cstage III-cN2 disease who received preoperative chemotherapy were compared with 649 patients receiving postoperative chemotherapy. In a Cox proportional hazards model with adjustment for demographics, comorbidities, and tumor attributes, the results of postoperative chemotherapy appeared similar to those of preoperative chemotherapy (hazard ratio [HR] = 1.05, 95% confidence interval [CI] 0.93-1.19, p = 0.438). In separate Cox models, the results of postoperative chemotherapy alone were similar to those of preoperative chemotherapy alone (HR = 1.106, 95% CI 0.91-1.344, p = 0.3124). The results of postoperative chemotherapy + radiation were similar to those of preoperative chemotherapy + radiation (HR = 1.125, 95% CI 0.949-1.333, p = -0.175).
  
  
  CONCLUSIONS
  Adjusted comparison of preoperative and postoperative chemotherapy results for cstage III-N2 NSCLC in the NCDB failed to identify a superior chemotherapy approach. This suggests that a more rigorous examination of the widely held view that preoperative chemotherapy is superior may be warranted.
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut. Electronic address: daniel.boffa@yale.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Jacquelyn G
authors.initials: JG
authors.lastname: Hancock
authors.affiliation: Yale Center for Analytic Sciences, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Xiaopan
authors.initials: X
authors.lastname: Yao
authors.affiliation: Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Sarah
authors.initials: S
authors.lastname: Goldberg
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Rosen
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Amy
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States