Stage IIIA-N2 non-small cell lung cancer (NSCLC): comparison of prognostic factors in 257 patients treated with surgery (S) versus induction chemotherapy plus surgery (IC+S) J. Vansteenkiste, C. Dooms, K. Nackaerts, P. De Leyn, B. Anrys, M. Demedts (Leuven, Belgium)
Source: Annual Congress 2002 - Thoracic oncology: diagnosis and prognosis
Session: Thoracic oncology: diagnosis and prognosis Session type: Oral PresentationNumber: 3728
Disease area: Thoracic oncologyAbstract Purpose: We previously described different prognostic subsets in surgically treated IIIA-N2 NSCLC (Ann Thorac Surg 63:1441-50, 1997). In this analysis, the impact of Vindesine-Ifosfamide-Cisplatin IC on this prognostication is examined. Method: With univariate and multivariate statistics, 140 S-pts. (all pN2) were compared to 117 IC+S-patients (mediastinoscopy proven N2) regarding clinical (performance status (PS), sex, symptoms, weight loss, CEA), tumor-related (endoscopy, T-stage, pathology), lymphatic spread (number and topography of metastatic lymph nodes (LN's)) and treatment-related (type of resection, response to IC, downstaging of LN's) characteristics. Results: Most of the historical pN2 pts. were resected after a negative mediastinoscopy. Those with a positive mediastinoscopy, nowadays candidates for IC, had a survival rate of 21% at 2 and 15% at 5 years. Favorable prognostic factors in this S-group were lower T-stage (P=.003), PS=0 (P=.02), squamous histology (P=.02) and only one metastatic lymph node level (P=.02). Despite the more extensive tumor burden in the IC+S cohort (e.g. one third of the S-group had "minimal-N2", none in the IC+S-group), their 2- and 5-year survival rates were 47% and 19%. For IC+S pts. responsive after IC, these results were 67% and 25%. Significant positive factors in the IC+S-pts. were, besides absence of subcarinal lymph node disease (P=.009), the achievement of response after IC (P=.0001), of complete resection (P=.001), or of mediastinal LN downstaging (P=.02). Conclusion: This non-randomized comparison, however based on experience in one single institution with standardized staging and treatment approaches over time, strongly suggests that stage IIIA-N2 patients do better with IC+S compared to S alone. When using IC+S, baseline prognostic factors related to the primary tumor or the LN spread become less relevant, except for metastasis in subcarinal nodes. Prognosis becomes mainly related to treatment-related factors, defined as response to IC, radical surgery, or downstaging of LN's.Rating:
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J. Vansteenkiste, C. Dooms, K. Nackaerts, P. De Leyn, B. Anrys, M. Demedts (Leuven, Belgium). Stage IIIA-N2 non-small cell lung cancer (NSCLC): comparison of prognostic factors in 257 patients treated with surgery (S) versus induction chemotherapy plus surgery (IC+S). Eur Respir J 2002; 20: Suppl. 38, 3728
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