title: Gender, Age, and Comorbidity Status Predict Improved Survival  with Adjuvant Chemotherapy Following Lobectomy  for Non-small Cell Lung Cancers Larger than 4 cm.
abstract: OBJECTIVE
  To identify pretreatment prognostic factors associated with improved outcomes in patients with non-small cell lung cancer (NSCLC) tumors larger than 4 cm receiving adjuvant chemotherapy following surgery versus surgery alone.
  
  
  METHODS
  Information was collected from the National Cancer Data Base on adults diagnosed with NSCLC who underwent lobectomy with or without adjuvant chemotherapy for pathologic T2 tumors measuring at least 4 cm, with no lymph node involvement or distant metastasis. The data were analyzed using model-based recursive partitioning for survival.
  
  
  RESULTS
  Patients who underwent chemotherapy following surgery experienced a survival benefit compared with patients who were treated with surgery alone (5-year survival of 66 vs. 49 %, p<0.0001). Overall, women had improved 5-year survival relative to men (60 vs. 47 %, p<0.0001). Despite this observation, three groups of women experienced no benefit from adjuvant chemotherapy:women 65-72 years with a Charlson-Deyo (CD) score ≥1 (5-year survival: 51 vs. 58 %, p = 0.29), women >72 with a CD score = 0 (5-year survival: 53 vs. 56 %, p = 0.57), and women >72 with a CD score ≥1 (5-year survival: 40 vs. 56 %, p = 0.04). By contrast, all groups of men identified by recursive partitioning analysis demonstrated improved survivals with adjuvant chemotherapy.
  
  
  CONCLUSIONS
  Adjuvant chemotherapy appears to increase survival for patients with resected NSCLC tumors larger than 4 cm. Women with NSCLC experience improved survival relative to men regardless of treatment. However,there are certain groups of women over 65 years old who do not benefit from adjuvant chemotherapy.
authors.forename: Britt J
authors.initials: BJ
authors.lastname: Sandler
authors.forename: Zuoheng
authors.initials: Z
authors.lastname: Wang
authors.forename: Jacquelyn G
authors.initials: JG
authors.lastname: Hancock
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; 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; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D012737:Sex Factors; D015996:Survival Rate; D055815:Young Adult