Difan Zheng1, Ting Ye1, Hong Hu1, Yawei Zhang1, Yihua Sun1, Jiaqing Xiang1, Haiquan Chen2. 1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China. 2. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China. Electronic address: hqchen1@yahoo.com.
Abstract
OBJECTIVE: Surgery plays an important role in the multidisciplinary treatment strategy for patients with stage IIIA non-small cell lung cancer (NSCLC). Besides induction therapy, patients could benefit from surgery followed by adjuvant chemotherapy and radiotherapy. This study analyzed a subset of patients with pIIIA NSCLC who underwent upfront surgery as first-line therapy. METHODS: Selected patients with pIIIA NSCLC who received upfront surgery were retrospectively analyzed. Clinicopathologic characteristics and survival outcomes including progression-free survival (PFS) and overall survival (OS) were evaluated. RESULTS: A total of 668 patients were identified. Five hundred sixty-five patients received adjuvant chemotherapy, and 157 patients received adjuvant radiotherapy after surgery. The median PFS and OS were 17.0 and 44.0 months, respectively. The 3-year and 5-year PFS rates were 31.6% and 21.0%, and the 3-year and 5-year OS rates were 54.7% and 43.0%. Patients with adenocarcinoma (AD) had better OS than those with squamous cell carcinoma (5-year OS: P = .026). Patients with low-grade AD (acinar and papillar) had a similar PFS and OS compared with patients with high-grade AD (solid, micropapillary, and mucinous) (5-year PFS: P = .894; 5-year OS: P = .439). Patients with mutated epidermal growth factor receptor had a similar OS to patients with wild-type epidermal growth factor receptor (5-year OS: P = .121). Patients with clinical N0 status (P = .004) and patients with single-station of pathologic N2 (P < .001) had better OS. CONCLUSIONS: Upfront surgery followed by adjuvant therapy may provide favorable survival outcomes for selected patients with pIIIA NSCLC, especially for patients with AD or patients with clinical N0 and pathologic single-station N2 diseases.
OBJECTIVE: Surgery plays an important role in the multidisciplinary treatment strategy for patients with stage IIIA non-small cell lung cancer (NSCLC). Besides induction therapy, patients could benefit from surgery followed by adjuvant chemotherapy and radiotherapy. This study analyzed a subset of patients with pIIIA NSCLC who underwent upfront surgery as first-line therapy. METHODS: Selected patients with pIIIA NSCLC who received upfront surgery were retrospectively analyzed. Clinicopathologic characteristics and survival outcomes including progression-free survival (PFS) and overall survival (OS) were evaluated. RESULTS: A total of 668 patients were identified. Five hundred sixty-five patients received adjuvant chemotherapy, and 157 patients received adjuvant radiotherapy after surgery. The median PFS and OS were 17.0 and 44.0 months, respectively. The 3-year and 5-year PFS rates were 31.6% and 21.0%, and the 3-year and 5-year OS rates were 54.7% and 43.0%. Patients with adenocarcinoma (AD) had better OS than those with squamous cell carcinoma (5-year OS: P = .026). Patients with low-grade AD (acinar and papillar) had a similar PFS and OS compared with patients with high-grade AD (solid, micropapillary, and mucinous) (5-year PFS: P = .894; 5-year OS: P = .439). Patients with mutated epidermal growth factor receptor had a similar OS to patients with wild-type epidermal growth factor receptor (5-year OS: P = .121). Patients with clinical N0 status (P = .004) and patients with single-station of pathologic N2 (P < .001) had better OS. CONCLUSIONS: Upfront surgery followed by adjuvant therapy may provide favorable survival outcomes for selected patients with pIIIA NSCLC, especially for patients with AD or patients with clinical N0 and pathologic single-station N2 diseases.