The long-term prognosis of induction chemotherapy followed by surgery for N2 non-small cell lung cancer: A retrospective case series study

Concurrent chemoradiotherapy using cisplatin and S-1, followed by surgery for stage II/IIIA non-small cell lung cancer

OBJECTIVES

Because chemoradiotherapy using cisplatin and S-1, an oral fluoropyrimidine, is effective for unresectable non-small cell lung cancer (NSCLC), an induction setting was used in a multicenter phase II study (Clinical trial number: UMIN000008205). The correlations of relapse and clinicopathological factors were analyzed.

METHODS

We defined locally advanced NSCLC as pathologically proven chest wall invasion or hilar and/or mediastinal lymph node metastases by endobronchial ultrasound-guided transbronchial needle aspiration. The patients received two courses of S-1 administration for 14 days and intravenous cisplatin injection on day 8. A total dose of 40 Gy radiotherapy was concurrently received. Surgical resection was performed after completion of the treatment.

RESULTS

Of the 23 eligible patients, 18 had stage IIIA and 5 had stage IIB NSCLC. Twenty of the eligible patients (87.0%) completed the regimen. Six (26.1%) complete responses were identified and 12 cases (52.2%) were histopathologically downstaged by induction chemoradiotherapy (ICRT). The 3-year overall survival rate was 58.1% and relapse-free survival (RFS) rate was 52.0%, respectively. Among several clinicopathological parameters, univariate RFS analysis identified that only downstaging was significantly associated with longer RFS times (p = 0.003). The radiological response did not reflect pathological response. When the variables of preoperative pathologically proven N2 metastasis, pathological ICRT effectiveness, and downstaging were included in the Cox proportional hazard modes, only the parameter of downstaging displayed significant hazard ratio (hazard ratio 0.13, p = 0.010).

CONCLUSION

This protocol is considered an option among preoperative therapies and has obvious benefits for pathologically downstaged cases.

CLINICAL TRIAL NUMBER

UMIN000008205.

TRIAL REGISTRATION DATE

June 19, 2012.

Impact of the staging method on the prognostic utility of the 8th AJCC staging system for non-small-cell lung cancer

Aim: To assess the impact of the staging method on the utility of the American Joint Committee on Cancer (AJCC) system for non-small-cell lung cancer. Methods: Surveillance, Epidemiology and End Results database was accessed and cancer-specific survival analyses were conducted. Results: For cancer-specific survival among pathologically staged patients, p-values for all pair wise comparisons were significant, except for stage IIIB versus IIIC; while among clinically staged patients, p-values for all pair wise comparisons were significant, except for stage IIA versus IIB. Among pathologically staged patients, AJCC eighth c-statistic was 0.705; while among clinically staged patients, AJCC eighth c-statistic was 0.687. Conclusion: The discriminatory power of eighth AJCC for non-small-cell lung cancer is lower for clinically staged compared with pathologically staged patients.