title: Prognostic factors in non-small cell lung cancer patients who received neoadjuvant therapy and curative resection.
abstract: BACKGROUND
  Lung cancer is the leading cause of cancer deaths in the world, and more and more treatment modalities have been introduced in order to improve patients' survival. For patients with advanced non-small cell lung cancer (NSCLC), survival prognosis is poor and multimodality neoadjuvant therapies are given to improve patients' survival. However, the possibility of occult metastases may lead to discrepancy between clinical and pathologic staging and underestimation of the disease severity. This discrepancy could be the reason for poor survival prediction reported by previous studies which conducted their analysis from the point of view of clinical stage. The aim of this study was to analyze the relationship between clinico-pathologic factors and survival from the pathologic point of view and to try to identify survival prognostic factors.
  
  
  METHODS
  From January 2005 to June 2011, 88 patients received neoadjuvant therapy because of initial locally advanced disease, followed by anatomic resection and mediastinal lymph node (LN) dissection. All their clinico-pathologic data were collected from a retrospective review of the medical records and subjected to further analysis.
  
  
  RESULTS
  We found that total metastatic LN ratio (P=0.01) and tumor size (P=0.02) were predictive factors for disease free survival (DFS). We used these two prognostic factors to stratify all patients into four groups. Group 4 (tumor size ≤5, total metastatic LN ratio ≤0.065) had the best DFS curve, while the DFS curve progressively deteriorated across group 3 (tumor size ≤5, total metastatic LN ratio >0.065), group 2 (tumor size >5, total metastatic LN ratio ≤0.065) and group 1 (tumor size >5, total metastatic LN ratio >0.065). However, no definitive prognostic factor could be identified in this study.
  
  
  CONCLUSIONS
  In conclusion, tumor size greater than 5 cm and total metastatic LN ratio greater than 0.065 could predict the DFS of patients with advanced NSCLC after multimodality therapies followed by surgical resection. Tumor size plays a more important role than total metastatic LN ratio in DFS. Moreover, patients identified with these factors need active post-operation surveillance and additional aggressive adjuvant therapies.
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch; Chang Gung University, Taoyuan, Taiwan ;
authors: Chen-Ping
authors: CP
authors: Hsieh
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch; Chang Gung University, Taoyuan, Taiwan ;
authors: Ming-Ju
authors: MJ
authors: Hsieh
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch; Chang Gung University, Taoyuan, Taiwan ;
authors: Ching-Feng
authors: CF
authors: Wu
authors: Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan Branch; Chang Gung University, Taoyuan, Taiwan.
authors: Jui-Ying
authors: JY
authors: Fu
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch; Chang Gung University, Taoyuan, Taiwan ;
authors: Yun-Hen
authors: YH
authors: Liu
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch; Chang Gung University, Taoyuan, Taiwan ;
authors: Yi-Cheng
authors: YC
authors: Wu
authors: Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan Branch; Chang Gung University, Taoyuan, Taiwan.
authors: Cheng-Ta
authors: CT
authors: Yang
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch; Chang Gung University, Taoyuan, Taiwan ;
authors: Ching-Yang
authors: CY
authors: Wu
keywords: Neoadjuvant therapy; lung cancer; prognostic factor