Paul J Speicher1, Lin Gu1, Xiaofei Wang1, Matthew G Hartwig1, Thomas A D'Amico1, Mark F Berry2. 1. From the Departments of Surgery and Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; and the Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California. 2. From the Departments of Surgery and Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; and the Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California. From the Departments of Surgery and Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; and the Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California.
Abstract
BACKGROUND: Evidence guiding adjuvant chemotherapy (AC) use after lobectomy for stage I non-small cell lung cancer (NSCLC) is limited. This study evaluated the impact of AC use and tumor size on outcomes using a large, nationwide cancer database. METHODS: The effect of AC on long-term survival among patients who underwent lobectomy for margin-negative pathologic T1-2N0M0 NSCLC in the National Cancer Data Base from 2003 to 2006 was estimated using the Kaplan-Meier method. The specific tumor size threshold at which AC began providing benefit was estimated with multivariable Cox proportional hazards modeling. RESULTS: Overall 3,496 of 34,360 patients (10.2%) who met inclusion criteria were treated with AC, although AC use increased over time from 2003, when only 2.7% of patients with tumors less than 4 cm and 6.2% of patients with tumors of 4 cm or larger received AC. In unadjusted survival analysis, AC was associated with a significant 5-year survival benefit for patients with tumors less than 4 cm (74.3% vs 66.9%; P<.0001) and 4 cm or greater (64.8% vs 49.8%; P<.0001). In subanalyses of patients grouped by strata of 0.5-cm increments in tumor size, AC was associated with a survival advantage for tumor sizes ranging from 3.0 to 8.5 cm. CONCLUSIONS: Use of AC among patients with stage I NSCLC has increased over time but remains uncommon. The results of this study support current treatment guidelines that recommend AC use after lobectomy for stage I NSCLC tumors larger than 4 cm. These results also suggest that AC use is associated with superior survival for patients with tumors ranging from 3.0 to 8.5 cm in diameter.
BACKGROUND: Evidence guiding adjuvant chemotherapy (AC) use after lobectomy for stage I non-small cell lung cancer (NSCLC) is limited. This study evaluated the impact of AC use and tumor size on outcomes using a large, nationwide cancer database. METHODS: The effect of AC on long-term survival among patients who underwent lobectomy for margin-negative pathologic T1-2N0M0 NSCLC in the National Cancer Data Base from 2003 to 2006 was estimated using the Kaplan-Meier method. The specific tumor size threshold at which AC began providing benefit was estimated with multivariable Cox proportional hazards modeling. RESULTS: Overall 3,496 of 34,360 patients (10.2%) who met inclusion criteria were treated with AC, although AC use increased over time from 2003, when only 2.7% of patients with tumors less than 4 cm and 6.2% of patients with tumors of 4 cm or larger received AC. In unadjusted survival analysis, AC was associated with a significant 5-year survival benefit for patients with tumors less than 4 cm (74.3% vs 66.9%; P<.0001) and 4 cm or greater (64.8% vs 49.8%; P<.0001). In subanalyses of patients grouped by strata of 0.5-cm increments in tumor size, AC was associated with a survival advantage for tumor sizes ranging from 3.0 to 8.5 cm. CONCLUSIONS: Use of AC among patients with stage I NSCLC has increased over time but remains uncommon. The results of this study support current treatment guidelines that recommend AC use after lobectomy for stage I NSCLC tumors larger than 4 cm. These results also suggest that AC use is associated with superior survival for patients with tumors ranging from 3.0 to 8.5 cm in diameter.
Authors: Jean-Yves Douillard; Rafael Rosell; Mario De Lena; Francesco Carpagnano; Rodryg Ramlau; Jose Luis Gonzáles-Larriba; Tomasz Grodzki; Jose Rodrigues Pereira; Alain Le Groumellec; Vito Lorusso; Claude Clary; Antonio J Torres; Jabrail Dahabreh; Pierre-Jean Souquet; Julio Astudillo; Pierre Fournel; Angel Artal-Cortes; Jacek Jassem; Leona Koubkova; Patricia His; Marcello Riggi; Patrick Hurteloup Journal: Lancet Oncol Date: 2006-09 Impact factor: 41.316
Authors: Timothy Winton; Robert Livingston; David Johnson; James Rigas; Michael Johnston; Charles Butts; Yvon Cormier; Glenwood Goss; Richard Inculet; Eric Vallieres; Willard Fry; Drew Bethune; Joseph Ayoub; Keyue Ding; Lesley Seymour; Barbara Graham; Ming-Sound Tsao; David Gandara; Kenneth Kesler; Todd Demmy; Frances Shepherd Journal: N Engl J Med Date: 2005-06-23 Impact factor: 91.245
Authors: Giorgio V Scagliotti; Roldano Fossati; Valter Torri; Lucio Crinò; Giuseppe Giaccone; Giovanni Silvano; Massimo Martelli; Maurizia Clerici; Francesco Cognetti; Maurizio Tonato Journal: J Natl Cancer Inst Date: 2003-10-01 Impact factor: 13.506
Authors: Katherine M W Pisters; William K Evans; Christopher G Azzoli; Mark G Kris; Christopher A Smith; Christopher E Desch; Mark R Somerfield; Melissa C Brouwers; Gail Darling; Peter M Ellis; Laurie E Gaspar; Harvey I Pass; David R Spigel; John R Strawn; Yee C Ung; Frances A Shepherd Journal: J Clin Oncol Date: 2007-10-22 Impact factor: 44.544
Authors: D Waller; M D Peake; R J Stephens; N H Gower; R Milroy; M K B Parmar; R M Rudd; S G Spiro Journal: Eur J Cardiothorac Surg Date: 2004-07 Impact factor: 4.191
Authors: Jean-Pierre Pignon; Hélène Tribodet; Giorgio V Scagliotti; Jean-Yves Douillard; Frances A Shepherd; Richard J Stephens; Ariane Dunant; Valter Torri; Rafael Rosell; Lesley Seymour; Stephen G Spiro; Estelle Rolland; Roldano Fossati; Delphine Aubert; Keyue Ding; David Waller; Thierry Le Chevalier Journal: J Clin Oncol Date: 2008-05-27 Impact factor: 44.544
Authors: Carmela Pepe; Baktiar Hasan; Timothy L Winton; Lesley Seymour; Barbara Graham; Robert B Livingston; David H Johnson; James R Rigas; Keyue Ding; Frances A Shepherd Journal: J Clin Oncol Date: 2007-04-20 Impact factor: 44.544
Authors: Stacyann Bailey; Qian Wang; Chung Yin Kong; Kimberly Stone; Rajwanth Veluswamy; Susan E Bates; Cardinale B Smith; Juan P Wisnivesky; Keith Sigel Journal: Curr Probl Cancer Date: 2022-05-21 Impact factor: 2.367
Authors: Takashi Eguchi; Kyuichi Kadota; Jamie Chaft; Brent Evans; John Kidd; Kay See Tan; Joe Dycoco; Kathryn Kolquist; Thaylon Davis; Stephanie A Hamilton; Kraig Yager; Joshua T Jones; William D Travis; David R Jones; Anne-Renee Hartman; Prasad S Adusumilli Journal: Oncotarget Date: 2016-06-07
Authors: Melissa A L Vyfhuis; Nasarachi Onyeuku; Tejan Diwanji; Sina Mossahebi; Neha P Amin; Shahed N Badiyan; Pranshu Mohindra; Charles B Simone Journal: Ther Adv Respir Dis Date: 2018 Jan-Dec Impact factor: 4.031