title: Evaluating the fate of patients who undergo resections of very large, node-negative lung cancers using the National Cancer DataBase.
abstract: OBJECTIVE
  To determine whether there are differences in survival associated with different treatment modalities among patients with lymph node-negative, very large non-small-cell lung cancers (NSCLCs).
  
  
  METHODS
  The National Cancer DataBase was used to identify patients diagnosed with NSCLCs >7 cm (T3) without lymph node involvement (N0) or metastatic disease (M0) from 1999 to 2006. Surgical therapy included surgery alone, neoadjuvant chemoradiation therapy or chemotherapy, surgery followed by adjuvant chemoradiation therapy or chemotherapy and surgery followed by postoperative radiation therapy (PORT). The 5-year overall survival (OS) was estimated by the Kaplan-Meier method and comparisons were made using log-rank tests and Cox regression models.
  
  
  RESULTS
  Of the 2296 patients identified with cT3N0M0 disease, 45% underwent surgical therapy. The 5-year OS rate was 38%. Across the different treatment regimens, there was a significant difference in 5-year OS. Neither neoadjuvant chemoradiation therapy or chemotherapy nor adjuvant chemoradiation therapy was associated with improved 5-year OS. The use of adjuvant chemotherapy was associated with improved OS relative to surgery alone [hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.54-0.91, P = 0.008]. PORT alone was associated with a detrimental effect on 5-year OS relative to surgery alone [HR 2.04; 95% CI 1.38-3.03, P < 0.001].
  
  
  CONCLUSIONS
  Large T3N0 NSCLCs appear to be optimally treated with surgical resection followed by adjuvant chemotherapy.
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Jia
authors.initials: J
authors.lastname: Liu
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Jacquelyn G
authors.initials: JG
authors.lastname: Hancock
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Moreno
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Zuoheng
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA anthony.kim@yale.edu.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden; D014481:United States
keywords: National Cancer DataBase; Non-small-cell lung cancer; T3N0