Survival benefit of surgery after chemoradiotherapy for stage III (N0-2) non-small-cell lung cancer is dependent on pathologic nodal response

Ellis Ziel, Gregory Hermann, Neilayan Sen, Philip Bonomi, Michael J. Liptay, Mary Jo Fidler, Marta Batus, William H. Warren, Gary Chmielewski, David J. Sher

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: The benefit of surgery (trimodality therapy [TMT]) after chemoradiotherapy (CRT) for patients with stage III non-smallcell lung cancer (NSCLC) is controversial, but nodal pathologic complete response (N-PCR) is accepted as a strong predictor of overall survival (OS). We compared the outcomes of patients treated with TMT versus CRT, focusing on the importance of N-PCR. Methods: Patients with stage III NSCLC treated with CRT or TMT from December 2004 through December 2012 were included; patients with N3 disease were excluded. Pathologic nodal response dichotomized surgical patients into N-PCR versus residual nodal disease (RND) groups. Actuarial OS, progression-free survival (PFS), and distant metastasis-free survival (DMFS) were compared between patients treated with CRT and TMT and between CRT and N-PCR/RND. Results: The cohort was composed of 138 patients (52% CRT and 48% TMT). The median OS was significantly higher after TMT than after CRT (81 versus 31.8 mo, p = 0.0068). This benefit was restricted to N-PCR (n = 50, 83.2 versus 31.8 mo, p = 0.0004), as RND (n = 19) experienced poor OS (16.1 mo). On multivariable analyses, N-PCR had superior OS (hazard ratio [HR], 0.38; p = 0.0012), PFS (HR, 0.42; p = 0.0005), and DMFS (HR, 0.42; p = 0.0007) compared with CRT. Conversely, there were trends for worse OS and PFS for RND versus CRT, although only inferior DMFS was significant (HR, 1.83; p = 0.04). Conclusions: Surgical patients with complete nodal clearance experienced superior survival, but those with RND fared no better than CRT alone. Mediastinal response may play an important role in the decision to proceed with surgical resection after CRT for stage III NSCLC.

Original languageEnglish (US)
Pages (from-to)1475-1480
Number of pages6
JournalJournal of Thoracic Oncology
Volume10
Issue number10
DOIs
StatePublished - Oct 1 2015

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Chemoradiotherapy
Non-Small Cell Lung Carcinoma
Survival
Disease-Free Survival
Lung Neoplasms
Neoplasm Metastasis
Therapeutics

Keywords

  • Chemoradiotherapy
  • Mediastinal staging
  • Non-small-cell lung cancer
  • Trimodality therapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Survival benefit of surgery after chemoradiotherapy for stage III (N0-2) non-small-cell lung cancer is dependent on pathologic nodal response. / Ziel, Ellis; Hermann, Gregory; Sen, Neilayan; Bonomi, Philip; Liptay, Michael J.; Fidler, Mary Jo; Batus, Marta; Warren, William H.; Chmielewski, Gary; Sher, David J.

In: Journal of Thoracic Oncology, Vol. 10, No. 10, 01.10.2015, p. 1475-1480.

Research output: Contribution to journalArticle

Ziel, Ellis ; Hermann, Gregory ; Sen, Neilayan ; Bonomi, Philip ; Liptay, Michael J. ; Fidler, Mary Jo ; Batus, Marta ; Warren, William H. ; Chmielewski, Gary ; Sher, David J. / Survival benefit of surgery after chemoradiotherapy for stage III (N0-2) non-small-cell lung cancer is dependent on pathologic nodal response. In: Journal of Thoracic Oncology. 2015 ; Vol. 10, No. 10. pp. 1475-1480.
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abstract = "Introduction: The benefit of surgery (trimodality therapy [TMT]) after chemoradiotherapy (CRT) for patients with stage III non-smallcell lung cancer (NSCLC) is controversial, but nodal pathologic complete response (N-PCR) is accepted as a strong predictor of overall survival (OS). We compared the outcomes of patients treated with TMT versus CRT, focusing on the importance of N-PCR. Methods: Patients with stage III NSCLC treated with CRT or TMT from December 2004 through December 2012 were included; patients with N3 disease were excluded. Pathologic nodal response dichotomized surgical patients into N-PCR versus residual nodal disease (RND) groups. Actuarial OS, progression-free survival (PFS), and distant metastasis-free survival (DMFS) were compared between patients treated with CRT and TMT and between CRT and N-PCR/RND. Results: The cohort was composed of 138 patients (52{\%} CRT and 48{\%} TMT). The median OS was significantly higher after TMT than after CRT (81 versus 31.8 mo, p = 0.0068). This benefit was restricted to N-PCR (n = 50, 83.2 versus 31.8 mo, p = 0.0004), as RND (n = 19) experienced poor OS (16.1 mo). On multivariable analyses, N-PCR had superior OS (hazard ratio [HR], 0.38; p = 0.0012), PFS (HR, 0.42; p = 0.0005), and DMFS (HR, 0.42; p = 0.0007) compared with CRT. Conversely, there were trends for worse OS and PFS for RND versus CRT, although only inferior DMFS was significant (HR, 1.83; p = 0.04). Conclusions: Surgical patients with complete nodal clearance experienced superior survival, but those with RND fared no better than CRT alone. Mediastinal response may play an important role in the decision to proceed with surgical resection after CRT for stage III NSCLC.",
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T1 - Survival benefit of surgery after chemoradiotherapy for stage III (N0-2) non-small-cell lung cancer is dependent on pathologic nodal response

AU - Ziel, Ellis

AU - Hermann, Gregory

AU - Sen, Neilayan

AU - Bonomi, Philip

AU - Liptay, Michael J.

AU - Fidler, Mary Jo

AU - Batus, Marta

AU - Warren, William H.

AU - Chmielewski, Gary

AU - Sher, David J.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Introduction: The benefit of surgery (trimodality therapy [TMT]) after chemoradiotherapy (CRT) for patients with stage III non-smallcell lung cancer (NSCLC) is controversial, but nodal pathologic complete response (N-PCR) is accepted as a strong predictor of overall survival (OS). We compared the outcomes of patients treated with TMT versus CRT, focusing on the importance of N-PCR. Methods: Patients with stage III NSCLC treated with CRT or TMT from December 2004 through December 2012 were included; patients with N3 disease were excluded. Pathologic nodal response dichotomized surgical patients into N-PCR versus residual nodal disease (RND) groups. Actuarial OS, progression-free survival (PFS), and distant metastasis-free survival (DMFS) were compared between patients treated with CRT and TMT and between CRT and N-PCR/RND. Results: The cohort was composed of 138 patients (52% CRT and 48% TMT). The median OS was significantly higher after TMT than after CRT (81 versus 31.8 mo, p = 0.0068). This benefit was restricted to N-PCR (n = 50, 83.2 versus 31.8 mo, p = 0.0004), as RND (n = 19) experienced poor OS (16.1 mo). On multivariable analyses, N-PCR had superior OS (hazard ratio [HR], 0.38; p = 0.0012), PFS (HR, 0.42; p = 0.0005), and DMFS (HR, 0.42; p = 0.0007) compared with CRT. Conversely, there were trends for worse OS and PFS for RND versus CRT, although only inferior DMFS was significant (HR, 1.83; p = 0.04). Conclusions: Surgical patients with complete nodal clearance experienced superior survival, but those with RND fared no better than CRT alone. Mediastinal response may play an important role in the decision to proceed with surgical resection after CRT for stage III NSCLC.

AB - Introduction: The benefit of surgery (trimodality therapy [TMT]) after chemoradiotherapy (CRT) for patients with stage III non-smallcell lung cancer (NSCLC) is controversial, but nodal pathologic complete response (N-PCR) is accepted as a strong predictor of overall survival (OS). We compared the outcomes of patients treated with TMT versus CRT, focusing on the importance of N-PCR. Methods: Patients with stage III NSCLC treated with CRT or TMT from December 2004 through December 2012 were included; patients with N3 disease were excluded. Pathologic nodal response dichotomized surgical patients into N-PCR versus residual nodal disease (RND) groups. Actuarial OS, progression-free survival (PFS), and distant metastasis-free survival (DMFS) were compared between patients treated with CRT and TMT and between CRT and N-PCR/RND. Results: The cohort was composed of 138 patients (52% CRT and 48% TMT). The median OS was significantly higher after TMT than after CRT (81 versus 31.8 mo, p = 0.0068). This benefit was restricted to N-PCR (n = 50, 83.2 versus 31.8 mo, p = 0.0004), as RND (n = 19) experienced poor OS (16.1 mo). On multivariable analyses, N-PCR had superior OS (hazard ratio [HR], 0.38; p = 0.0012), PFS (HR, 0.42; p = 0.0005), and DMFS (HR, 0.42; p = 0.0007) compared with CRT. Conversely, there were trends for worse OS and PFS for RND versus CRT, although only inferior DMFS was significant (HR, 1.83; p = 0.04). Conclusions: Surgical patients with complete nodal clearance experienced superior survival, but those with RND fared no better than CRT alone. Mediastinal response may play an important role in the decision to proceed with surgical resection after CRT for stage III NSCLC.

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KW - Mediastinal staging

KW - Non-small-cell lung cancer

KW - Trimodality therapy

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