Ichiro Yoshino1. 1. Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan, iyoshino@faculty.chiba-u.jp.
Abstract
PURPOSE: Effective adjuvant chemotherapy (Adj.C) for completely resected non-small cell lung cancer (NSCLC) was recently established. However, there may be some unresolved adverse effects, as have been observed in early stage populations or long-term survivors after other types of Adj.C. The substantial risk in such patients was examined by a mathematical method. METHODS: Variables X and Y were defined by two outcomes of Adj.C: X = the ability to eliminate micro-metastasis and Y = the development of effects that threaten life. Then, the following formula was generated: Survival benefit = (death rate) X - (death rate) X Y - (survival rate) Y. We then solved for X and Y and verified our findings using reported data from clinical trials. RESULTS: By solving two simultaneous equations for the formula applied to the data for stage (1) IA and (2) IIIA in the LACE study (J Clin Oncol 26:5043-5051, 2008), X and Y were 2.6 and 1.9, respectively. When these values were applied in the formula for stage IB patients in the same study, the theoretical (-2.3 %) and reported values (2.5 %) were close. When these were applied for stage IB-IIIA patients in the IALT study (N Engl J Med 350:351-360, 2004), the theoretical (5.0 %) and reported values (4.1 %) were also similar. CONCLUSION: Assuming a substantial risk provides an explanation for the stage-dependent outcomes of Adj.C for completely resected NSCLC.
PURPOSE: Effective adjuvant chemotherapy (Adj.C) for completely resected non-small cell lung cancer (NSCLC) was recently established. However, there may be some unresolved adverse effects, as have been observed in early stage populations or long-term survivors after other types of Adj.C. The substantial risk in such patients was examined by a mathematical method. METHODS: Variables X and Y were defined by two outcomes of Adj.C: X = the ability to eliminate micro-metastasis and Y = the development of effects that threaten life. Then, the following formula was generated: Survival benefit = (death rate) X - (death rate) X Y - (survival rate) Y. We then solved for X and Y and verified our findings using reported data from clinical trials. RESULTS: By solving two simultaneous equations for the formula applied to the data for stage (1) IA and (2) IIIA in the LACE study (J Clin Oncol 26:5043-5051, 2008), X and Y were 2.6 and 1.9, respectively. When these values were applied in the formula for stage IB patients in the same study, the theoretical (-2.3 %) and reported values (2.5 %) were close. When these were applied for stage IB-IIIA patients in the IALT study (N Engl J Med 350:351-360, 2004), the theoretical (5.0 %) and reported values (4.1 %) were also similar. CONCLUSION: Assuming a substantial risk provides an explanation for the stage-dependent outcomes of Adj.C for completely resected NSCLC.
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