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Zeng J, Cui X, Cheng L, Chen Y, Du X, Sheng L. Micropapillary pattern of stage IIIA-N 2 lung adenocarcinoma is a prognostic factor after adjuvant chemoradiotherapy. Future Oncol 2020; 16:3075-3084. [PMID: 32869661 DOI: 10.2217/fon-2020-0597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: This study aims to investigate the significance of a micropapillary pattern in stage IIIA-N2 lung adenocarcinoma after adjuvant chemoradiotherapy. Patients & methods: A total of 257 patients with stage IIIA-N2 lung adenocarcinoma were enrolled in this study. Patients were classified into three groups based on the proportion of micropapillary components: micropapillary negative, micropapillary minor component and micropapillary predominant component. Results: The micropapillary predominant group had the shortest median disease-free survival and overall survival times compared with the micropapillary minor component and micropapillary negative groups (median overall survival time: 54 months vs 64 months vs not reached; p = 0.004). Furthermore, the micropapillary pattern was an independent prognostic factor for disease-free survival and overall survival (p < 0.05). Conclusion: The micropapillary pattern of IIIA-N2 lung adenocarcinoma is related to worse prognosis.
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Affiliation(s)
- Jian Zeng
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
| | - Xiaoying Cui
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China.,The Second Clinical Medical College, Zhejiang Chinese Medical University
| | - Lei Cheng
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
| | - Ying Chen
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
| | - Xianghui Du
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
| | - Liming Sheng
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
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Wei W, Zhou J, Zhang Q, Liao DH, Liu QD, Zhong BL, Liang ZB, Zhang YC, Jiang R, Liu GY, Xu CY, Li Zhou H, Zhu SY, Yang N, Jiang W, Liu ZG. Postoperative intensity-modulated radiation therapy reduces local recurrence and improves overall survival in III-N2 non-small-cell lung cancer: A single-center, retrospective study. Cancer Med 2020; 9:2820-2832. [PMID: 32100444 PMCID: PMC7163098 DOI: 10.1002/cam4.2937] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/02/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To determine the postoperative effects of radiotherapy (PORT) on the local recurrence‐free survival (LRFS) and overall survival (OS) of stage III‐N2 non‐small‐cell lung cancer (NSCLC). Materials and Methods 183 patients with resected stage III‐pN2 NSCLC from Hunan Cancer Hospital between 2013 and 2016 were divided into two groups for postoperative chemotherapy (POCT) (n = 105) or combination chemotherapy and radiotherapy (POCRT) (n = 78). The LRFS and OS were compared and the factors affecting local recurrence were illustrated in these two groups. The sites of failure based on the lobe of the primary tumor in two groups were described. Results PORT leads to a strikingly lower risk for local recurrence and brought superior OS benefit. For different pN2 Subclassification, Patients with multiple‐station pN2 ± pN1 disease had the worst LRFS (11 months) and single‐station pN2 + multiple station pN1 disease had a relatively short LRFS (24 months) in group POCT. Short LRFS is correlated with multiple‐station pN2, older age (Y > 55), patients with a high positive LN ratio > 1/3 and a poor tumor histological differentiation degree. In group POCT, the most frequent failure site occurs at the ipsilateral hilum (21.0%), the bronchial stump (20.0%), followed by LNs4R (19.0%), LNs4L (18.1%), LNs7 (15.2%), most of left‐sided tumors more frequently involved the contralateral mediastinum, whereas the ipsilateral recurrences dominated for right‐sided tumors, especially for LNs4R. In group POCRT, the highest failure site was the bronchial stump (11.5%), followed by LNs4L (8.97%), LNs1 (7.69%), the ipsilateral hilum (6.41%) and LNs4R (6.41%). Conclusion PORT remarkably reduced local recurrence and improved OS in stage III‐pN2 NSCLC, especially in the multiple‐station pN2 group.
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Affiliation(s)
- Wei Wei
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Jiao Zhou
- Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.,Department of Clinical Medicine, University of South China, Hengyang, China
| | - Qun Zhang
- Department of Radiotherapy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - De-Hua Liao
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Qiao-Dan Liu
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Bei-Long Zhong
- Department of Thoracic Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Zi-Bin Liang
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Yong-Chang Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Rong Jiang
- Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.,Department of Clinical Medicine, University of South China, Hengyang, China
| | - Gui-Yun Liu
- Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.,Department of Clinical Medicine, University of South China, Hengyang, China
| | - Chen-Yang Xu
- Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.,Department of Clinical Medicine, University of South China, Hengyang, China
| | - Huai- Li Zhou
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Su-Yu Zhu
- Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Nong Yang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Wen Jiang
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, USA
| | - Zhi-Gang Liu
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
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3
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Su L, Chen M, Su H, Dai Y, Chen S, Li J. Postoperative chemoradiotherapy is superior to postoperative chemotherapy alone in squamous cell lung cancer patients with limited N2 lymph node metastasis. BMC Cancer 2019; 19:1023. [PMID: 31666026 PMCID: PMC6820909 DOI: 10.1186/s12885-019-6141-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/06/2019] [Indexed: 12/24/2022] Open
Abstract
Background The aim of the present study was to assess the efficacy of postoperative chemoradiotherapy (POCRT) following surgery in non-small-cell lung cancer patients with N2 lymph node metastasis (N2-NSCLC). Methods The clinical data of patients with N2-NSCLC treated with POCRT or postoperative chemotherapy (pCT) alone were retrospectively collected and reviewed. The overall survival (OS) rates were analyzed utilizing the Kaplan-Meier method and compared by the log-rank test. Cox regression analysis was used to determine factors significantly associated with survival. Propensity score matching (PSM) analysis was used to compensate for differences in baseline characteristics and OS was compared after matching. Results Between 2004 and 2014, a total of 175 patients fulfilled the inclusion criteria, 60 of whom were treated with POCRT, while 115 were administered pCT. The 1, 3 and 5-year OS rates in the POCRT and pCT groups were 98.3 vs. 86.1%, 71.7 vs. 53.0% and 45.7 vs. 39.0%, respectively (P = 0.019). Compared with pCT, POCRT improved OS in patients with squamous cell subtype (P = 0.010), no lymphovascular invasion (P = 0.006), pN2a (P = 0.006) or total number of metastatic lymph nodes ≤7 (P = 0.016). After PSM, these survival differences between POCRT and pCT remained significant in patients with squamous cell lung cancer (P = 0.010). Conclusions POCRT following complete resection may be beneficial for patients with squamous cell lung cancer, particularly those with limited nodal involvement.
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Affiliation(s)
- Liyu Su
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China.,Fujian Medical University, Fujian, 350122, China.,Department of Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Mingqiu Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China.,Fujian Provincial Platform for Medical Laboratory Research of First Affiliated Hospital, Fujian, China
| | - Huiyan Su
- Department of Radiation Oncology, Fujian Children's Hospital, Fujian, China
| | - Yaqing Dai
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Fujian, China
| | - Shaoxing Chen
- Department of Radiation Oncology, The 175th Hospital of PLA (The Chinese People's Liberation Army), Fujian, China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China.
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4
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Berzenji L, Beckers P, Van Schil PE. Surgery for stage IIIA-N2 non-small cell lung cancer: the jury is still out! J Thorac Dis 2019; 11:S1153-S1156. [PMID: 31245070 DOI: 10.21037/jtd.2019.04.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Belgium
| | - Paul Beckers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Belgium
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Shang X, Li Z, Lin J, Wang H, Wang Z. PLNR≤20% may be a benefit from PORT for patients with IIIA-N2 NSCLC: a large population-based study. Cancer Manag Res 2018; 10:3561-3567. [PMID: 30271204 PMCID: PMC6152602 DOI: 10.2147/cmar.s173856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Our study was to evaluate the influence of positive lymph nodes ratio (PLNR) on survival for patients with pathological stage IIIA-N2 non-small cell lung cancer (NSCLC) after receiving postoperative radiotherapy (PORT). Patients and methods The chi-squared test was used to compare the patient baseline characteristics. Cox proportional hazard model was used to analyze the influence of different variables on overall survival (OS). X-tile model was applied to determine the cutoff values of PLNR. Kaplan–Meier method and log-rank test were used to compare survival differences. Based on different cutoff values of PLNR, Cox proportional hazard model was also used to analyze the influence factors on OS. Results Multivariate Cox regression analysis showed that PLNR (P=0.001) and PORT (HR=1.283; 95% CI 1.154–1.426; P<0.001) were significant independent prognostic factors for OS in patients with resected IIIA-N2 NSCLC. The X-tile model was used to screen three different cutoff values including PLNR≤20%, 20%<PLNR≤40%, PLNR>40%. Based on these different cutoff values, we found that patients with PLNR≤20% receiving PORT have a better OS (P=0.007). Further multivariable analysis showed that PORT is an independent prognostic factor of OS only for patients with PLNR≤20% (HR=1.328; 95% CI 1.139–1.549; P<0.001). Conclusion: PLNR≤20% may be a prognostic factor for patients with IIIA-N2 NSCLC receiving PORT.
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Affiliation(s)
- Xiaoling Shang
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
| | - Zhenxiang Li
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
| | - Jiamao Lin
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
| | - Haiyong Wang
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
| | - Zhehai Wang
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
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6
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Lou Y, Dholaria B, Soyano A, Hodge D, Cochuyt J, Manochakian R, Ko SJ, Thomas M, Johnson MM, Patel NM, Miller RC, Adjei AA, Ailawadhi S. Survival trends among non-small-cell lung cancer patients over a decade: impact of initial therapy at academic centers. Cancer Med 2018; 7:4932-4942. [PMID: 30175515 PMCID: PMC6198232 DOI: 10.1002/cam4.1749] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/22/2018] [Accepted: 08/04/2018] [Indexed: 12/15/2022] Open
Abstract
Background Treatment of non‐small‐cell lung cancer (NSCLC) has been rapidly advancing over the last decade. Academic centers are considered equipped with better expertise. NSCLC outcome trends in novel therapeutic era and impact of initial treatment at academic centers have not been reported. Methods The National Cancer Database (NCDB) was used to identify NSCLC incident cases from 2004 to 2013. Overall survival (OS) was plotted by year of diagnosis and type of initial treatment center, accounting for several factors available in NCDB. Results A total of 1 150 722 NSCLC patients were included and separated by initial treatment center type (academic: 31.5%; nonacademic: 68.5%). Median follow‐up and OS for all patients were 11.8 months (range: 0‐133.6 months) and 13.1 months (95% CI: 13.08‐13.17), respectively. Median OS improved significantly for those diagnosed in 2010‐2013 (14.8 months [95% CI: 14.7‐14.9]) as compared to 2004‐2009 (12.4 months [95% CI: 12.3‐12.5]) (P < 0.001). Treatment at academic centers was associated with improved OS (multivariate HR for OS = 0.929 [95% CI: 0.92‐0.94], P < 0.0010). Four‐year OS for academic and nonacademic cohorts was 28.5%% and 22.1%, respectively (P < 0.001), and the difference was more pronounced in stage I to III NSCLC. Conclusion In this largest analysis, thus far, NSCLC survival has improved over time, and type of initial treatment center significantly influences survival. Identifying and removing barriers to obtaining initial treatment of NSCLC at academic medical centers could improve OS.
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Affiliation(s)
- Yanyan Lou
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Aixa Soyano
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - David Hodge
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Jordan Cochuyt
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Rami Manochakian
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- Department of Cardiovascular Thoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Margaret M Johnson
- Division of Allergy and Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida
| | - Neal M Patel
- Division of Allergy and Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Alex A Adjei
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Hofmann HS, Braess J, Leipelt S, Allgäuer M, Klinkhammer-Schalke M, Szoeke T, Grosser C, Pfeifer M, Ried M. Multimodality therapy in subclassified stage IIIA-N2 non-small cell lung cancer patients according to the Robinson classification: heterogeneity and management. J Thorac Dis 2018; 10:3585-3594. [PMID: 30069356 DOI: 10.21037/jtd.2018.05.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) with mediastinal lymph node involvement (N2) is a heterogeneous entity. The objective of this analysis is to investigate the results of treatment strategies for N2-positive patients. Methods Retrospective study (2009-2014) of 104 consecutive patients with stage IIIA-N2 NSCLC classified according to the Robinson classification (IIIA1-IIIA4) and treated within a multimodality treatment regime. Results The Robinson subgroups were: IIIA1 (n=27), IIIA3 (n=60) and IIIA4 (n=17). We had no stage IIIA2 samples because we did not perform an intraoperative frozen section of lymph nodes. Surgical resection with systematic lymph node dissection was performed in all patients with stage IIIA1 (n=27). After chemotherapy or chemo-/radiotherapy, 53.3% of patients in stage IIIA3 (n=32) and 11.7% of patients in stage IIIA4 (n=2) underwent surgery with curative intention. R0 was achieved in 92.6% in stage IIIA1, 93.8% in stage IIIA3 and 100% in stage IIIA4. The 30-day mortality was 3.2%. The overall median survival was 31.7 months (5-year survival was 30.5%). There were no significant differences (P=0.583) in survival regarding the Robinson subgroups. Patients who underwent tumour resection had significantly better median survival (39.8 vs. 19.6 months; P=0.014) compared to patients treated conservatively. Deviation from the interdisciplinary recommended therapy (12%) led to a reduced median survival (11.4 vs. 31.8 months; P=0.137). Conclusions N2-patients should be subclassified according to the Robinson classification and discussed in the tumour board. Surgical resection should be recommended in specific cases of N2-disease (non-bulky, sensitivity to systemic treatment).
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Affiliation(s)
- Hans-Stefan Hofmann
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany.,Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Susanne Leipelt
- Department of Oncology and Hematology, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Michael Allgäuer
- Department of Radiotherapy, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | | | - Tamas Szoeke
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Christian Grosser
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Michael Pfeifer
- Department of Pneumology, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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8
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Kou P, Wang H, Lin J, Zhang Y, Yu J. Male patients with resected IIIA-N2 non-small-cell lung cancer may benefit from postoperative radiotherapy: a population-based survival analysis. Future Oncol 2018; 14:2371-2381. [PMID: 29807451 DOI: 10.2217/fon-2018-0326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM Our analysis was performed to assess the efficacy of postoperative radiotherapy (PORT) on the survival for pathologic IIIA-N2 Non-small-cell lung cancer patients. PATIENTS & METHODS We identified 2949 patients from 2004 to 2013 in the SEER database. Propensity score-matching was used to reduce the selection bias. Overall survival (OS), cancer-specific survival (CSS) and the factors associated with survival prognosis were evaluated. RESULTS There was no significant difference in OS and CSS between PORT and non-PORT groups. However, subgroup analysis revealed an OS (p = 0.007) and CSS (p = 0.006) detrimental for male patients not receiving PORT. Multivariate analysis showed that old age, male sex, high pathologic grade, squamous carcinoma, bigger tumor size and larger number of positive lymph nodes had a negative impact on survival. CONCLUSION PORT could improve OS and CSS in male patients with resected IIIA-N2 non-small-cell lung cancer.
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Affiliation(s)
- Peisi Kou
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Haiyong Wang
- Department of internal Medicine-Oncology, Shandong Cancer Hospital & Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, PR China
| | - Jiamao Lin
- Department of internal Medicine-Oncology, Shandong Cancer Hospital & Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, PR China
| | - Yan Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, PR China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, PR China
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9
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Progress in the Management of Early-Stage Non-Small Cell Lung Cancer in 2017. J Thorac Oncol 2018; 13:767-778. [PMID: 29654928 DOI: 10.1016/j.jtho.2018.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/17/2022]
Abstract
The landscape of care for early-stage non-small cell lung cancer continues to evolve. While some of the developments do not seem as dramatic as what has occurred in advanced disease in recent years, there is a continuous improvement in our ability to diagnose disease earlier and more accurately. We have an increased understanding of the diversity of early-stage disease and how to better tailor treatments to make them more tolerable without impacting efficacy. The International Association for the Study of Lung Cancer and the Journal of Thoracic Oncology publish this annual update to help readers keep pace with these important developments. Experts in the care of early-stage lung cancer patients have provided focused updates across multiple areas including screening, pathology, staging, surgical techniques and novel technologies, adjuvant therapy, radiotherapy, surveillance, disparities, and quality of life. The source for information includes large academic meetings, the published literature, or novel unpublished data from other international oncology assemblies.
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Van Schil PE, Yogeswaran K, Hendriks JM, Lauwers P, Faivre-Finn C. Advances in the use of surgery and multimodality treatment for N2 non-small cell lung cancer. Expert Rev Anticancer Ther 2017; 17:555-561. [PMID: 28403675 DOI: 10.1080/14737140.2017.1319766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stage IIIA-N2 non-small cell lung cancer (NSCLC) represents a heterogeneous group of bronchogenic carcinomas with locoregional involvement. Different categories of N2 disease exist, ranging from unexpectedly encountered N2 involvement after detailed preoperative staging or 'surprise' N2, to potentially resectable disease treated within a combined modality setting, and finally, bulky N2 involvement treated by chemoradiation. Areas covered: Large randomised controlled trials and meta-analyses on stage IIIA-N2 NSCLC have been published but their implications for treatment remain a matter of debate. No definite recommendations can be provided as diagnostic and therapeutic algorithms vary according to local, national or international guidelines. Expert commentary: From the literature, it is clear that patients with stage IIIA-N2 NSCLC should be treated by combined modality therapy including chemotherapy, radiotherapy and surgery. The relative contribution of each modality has not been firmly established. For patients undergoing induction therapy, adequate restaging is important as only down-staged patients will clearly benefit from surgical resection. Each patient should be discussed within a multidisciplinary team to determine the best diagnostic and therapeutic approach according to the specific local expertise. In the near future, it might be expected that targeted therapies and immunotherapy will be incorporated as possible therapeutic options.
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Affiliation(s)
- Paul E Van Schil
- a Department of Thoracic and Vascular Surgery , Antwerp University Hospital , Edegem (Antwerp) , Belgium
| | - Krishan Yogeswaran
- a Department of Thoracic and Vascular Surgery , Antwerp University Hospital , Edegem (Antwerp) , Belgium
| | - Jeroen M Hendriks
- a Department of Thoracic and Vascular Surgery , Antwerp University Hospital , Edegem (Antwerp) , Belgium
| | - Patrick Lauwers
- a Department of Thoracic and Vascular Surgery , Antwerp University Hospital , Edegem (Antwerp) , Belgium
| | - Corinne Faivre-Finn
- b Division of Molecular and Clinical Cancer Sciences , University of Manchester , Manchester , UK
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11
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Subotic D, Van Schil P, Grigoriu B. Optimising treatment for post-operative lung cancer recurrence. Eur Respir J 2016; 47:374-8. [PMID: 26828046 DOI: 10.1183/13993003.01490-2015] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dragan Subotic
- Clinic of Thoracic Surgery, Clinical Centre of Serbia, University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Paul Van Schil
- Dept of Thoracic and Vascular Surgery, University Hospital, Antwerp, Belgium
| | - Bogdan Grigoriu
- Dept of Pulmonology, University of Medicine and Pharmacy, Iasi, Romania
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Herskovic A, Mauer E, Christos P, Nagar H. Role of Postoperative Radiotherapy in Pathologic Stage IIIA (N2) Non-Small Cell Lung Cancer in a Prospective Nationwide Oncology Outcomes Database. J Thorac Oncol 2016; 12:302-313. [PMID: 27746190 DOI: 10.1016/j.jtho.2016.09.135] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/09/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The role of postoperative radiotherapy (PORT) in the treatment of pathologic stage IIIA (N2) NSCLC remains controversial. We investigated practice patterns and outcomes for these patients in a prospectively maintained nationwide oncology outcomes database. METHODS Patients with known histologic features of pathologic stage IIIA (N2) NSCLC who underwent an operation with negative margins and received adjuvant multiagent chemotherapy from 2004 to 2013 were identified from the National Cancer Data Base and stratified by the use of PORT. Multivariable logistic regression modeling was used to examine factors associated with receiving PORT, and multivariable proportional hazards regression was used to examine the association of treatment and mortality, adjusting for demographic, socioeconomic and clinicopathologic factors. Landmark analysis and covariate balancing propensity score (CBPS) weighting were also explored to account for immortal time bias and nonrandomization. RESULTS A total of 2691 patients were identified, with a median follow-up of 32.32 months. In multivariable analysis, improved overall survival was associated with multiple factors, including younger age, female sex, lower Charlson-Deyo comorbidity index, histologic type (with squamous cell being better than adenocarcinoma), smaller tumor size, lower pathologic T stage, surgical procedure (with pneumonectomy or lobectomy being better than sublobar resection), and receipt of PORT (all p < 0.05). Before landmark analysis, the hazard ratio (HR) showed an overall survival benefit for patients receiving PORT (adjusted HR = 0.83, 95% CI [confidence interval]: 0.72-0.95; p = 0.008). This benefit remained significant after CBPS weighting (HR = 0.81, 95% CI: 0.70-0.94, p = 0.005), almost significant after landmark analysis (adjusted HR = 0.84, 95% CI: 0.69-1.007, p = 0.059), and significant after landmark analysis with CBPS weighting (HR = 0.77, 95% CI: 0.63-0.94, p = 0.009). Median survival past landmark time was 27.43 months in the PORT group and 25.86 months in the non-PORT group. Factors significantly associated with receiving PORT were facility location, facility type, Charlson-Deyo comorbidity index, and grade (all p < 0.05). CONCLUSIONS Improved survival is associated with receipt of PORT for patients with pathologic stage IIIA (N2) NSCLC treated with complete resection and multiagent chemotherapy.
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Affiliation(s)
- Alex Herskovic
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York.
| | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Paul Christos
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York
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Robinson CG, Patel AP, DeWees T, Morgensztern D, Bradley JD, Puri V. Reply to C. Le Péchoux et al and B.S. Gill et al. J Clin Oncol 2015. [PMID: 26215956 DOI: 10.1200/jco.2015.62.5731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Todd DeWees
- Washington University in St Louis, St Louis, MO
| | | | | | - Varun Puri
- Washington University in St Louis, St Louis, MO
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