title: Surgery for Stage IIIA Non-Small-cell Lung Cancer: Lack of Predictive and Prognostic Factors Identifying Any Subgroup of Patients Benefiting From It.
abstract: Although a trimodality regimen for patients with stage IIIA/pN2 non-small-cell lung cancer (NSCLC) has been variably used owing to limited evidence for its benefits, it remains unknown whether any patient subgroup actually receives benefit from such an approach. To explore this question, the published data were reviewed from 1990 to 2015 to identify the possible predictors and prognosticators in this setting. Overall survival was the endpoint of our study. Of 27 identified studies, none had studied the predictors of improved outcomes with trimodality treatment. Of the potential patient- and tumor-related prognosticators, age, gender, and histologic type were the most frequently formally explored. However, none of the 3 was found to influence overall survival. The most prominent finding of the present review was the substantial lack of data supporting a trimodality treatment approach in any patient subgroup. As demonstrated in completed prospective randomized studies, the use of surgery for stage IIIA NSCLC should be limited to well-defined clinical trials.
authors.affiliation: Institute of Lung Diseases, Sremska Kamenica, Serbia. Electronic address: nebareje@gmail.com.
authors.forename: Branislav
authors.initials: B
authors.lastname: Jeremić
authors.affiliation: University Clinic, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Casas
authors.affiliation: University Hospital to East Slovakia Institute of Oncology, Kosice, Slovakia.
authors.forename: Pavol
authors.initials: P
authors.lastname: Dubinsky
authors.affiliation: University Hospital, Santiago de Compostela, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gomez-Caamano
authors.affiliation: Inselspital, Bern, Switzerland.
authors.forename: Nikola
authors.initials: N
authors.lastname: Čihorić
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Greg
authors.initials: G
authors.lastname: Videtic
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D006801:Humans; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: NSCLC; Predictive factors; Prognostic factors; Trimodality therapy; pN2 disease