TY - JOUR
T1 - Prognostic factors for resected non-small cell lung cancer with pN2 status
T2 - Implications for use of postoperative radiotherapy
AU - Moretti, Luigi
AU - Yu, David S.
AU - Chen, Heidi
AU - Carbone, David P.
AU - Johnson, David H.
AU - Keedy, Vicki L.
AU - Putnam, Joe B.
AU - Sandler, Alan B.
AU - Shyr, Yu
AU - Lu, Bo
PY - 2009
Y1 - 2009
N2 - Background. For non-small cell lung cancer (NSCLC) patients with pN2 status, the use of postoperative radiotherapy (PORT) remains controversial. Here, we investigated the association between different clinico-pathological features and postoperative therapy and local control and survival in patients with resected pN2 NSCLC. Methods. We retrospectively analyzed 83 patients with pN2 NSCLC who underwent resection at Vander-bilt University Medical Center between 1994 and 2004. The relationship between 10 prognostic factors - gender, age at diagnosis, histology, tumor size, number of nodal stations involved, positive node number, surgical margin, extracapsular extension (ECE), and use of postoperative chemotherapy and PORT - and 2-year local recurrence-free survival (LRFS), distant recurrencefree survival (DRFS), recurrence-free survival (RFS), and overall survival (OS) rates was evaluated. Univariate and multivariate analyses were conducted using the Kaplan - Meier method and Cox proportional hazards ratios, respectively. Results. On univariate analysis, PORT was significantly associated with greater LRFS, RFS, and OS rates, whereas chemotherapy was associated with a trend toward a higher OS rate. Negative surgical margins were predictive of a higher OS rate, and negative ECE was associated with higher LRFS and RFS rates. On multivariate analysis, only PORT and negative ECE were associated with a higher LRFS rate. On subgroup analysis, in negative ECE patients, PORT was significantly associated with a higher OS rate. Conclusions. PORT is associated with a higher OS rate for patients with resected pN2 NSCLC with negative ECE but not with positive ECE. The absence of ECE may serve as a useful prognostic variable in the selection of pN2 NSCLC patients for PORT and warrants further investigation in randomized clinical trials.
AB - Background. For non-small cell lung cancer (NSCLC) patients with pN2 status, the use of postoperative radiotherapy (PORT) remains controversial. Here, we investigated the association between different clinico-pathological features and postoperative therapy and local control and survival in patients with resected pN2 NSCLC. Methods. We retrospectively analyzed 83 patients with pN2 NSCLC who underwent resection at Vander-bilt University Medical Center between 1994 and 2004. The relationship between 10 prognostic factors - gender, age at diagnosis, histology, tumor size, number of nodal stations involved, positive node number, surgical margin, extracapsular extension (ECE), and use of postoperative chemotherapy and PORT - and 2-year local recurrence-free survival (LRFS), distant recurrencefree survival (DRFS), recurrence-free survival (RFS), and overall survival (OS) rates was evaluated. Univariate and multivariate analyses were conducted using the Kaplan - Meier method and Cox proportional hazards ratios, respectively. Results. On univariate analysis, PORT was significantly associated with greater LRFS, RFS, and OS rates, whereas chemotherapy was associated with a trend toward a higher OS rate. Negative surgical margins were predictive of a higher OS rate, and negative ECE was associated with higher LRFS and RFS rates. On multivariate analysis, only PORT and negative ECE were associated with a higher LRFS rate. On subgroup analysis, in negative ECE patients, PORT was significantly associated with a higher OS rate. Conclusions. PORT is associated with a higher OS rate for patients with resected pN2 NSCLC with negative ECE but not with positive ECE. The absence of ECE may serve as a useful prognostic variable in the selection of pN2 NSCLC patients for PORT and warrants further investigation in randomized clinical trials.
KW - Adjuvant radiotherapy
KW - Extracapsular extension
KW - Non-small cell lung cancer
KW - Prognostic factors
KW - pN2
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U2 - 10.1634/theoncologist.2009-0130
DO - 10.1634/theoncologist.2009-0130
M3 - Article
C2 - 19897534
AN - SCOPUS:75449108663
SN - 1083-7159
VL - 14
SP - 1106
EP - 1115
JO - Oncologist
JF - Oncologist
IS - 11
ER -