Outcomes and prognostic factors of non-small-cell lung cancer with lymph node involvement treated with induction treatment and surgical resection

Giuseppe Marulli, Enrico Verderi, Andrea Zuin, Marco Schiavon, Lucia Battistella, Egle Perissinotto, Paola Romanello, Adolfo Gino Favaretto, Giulia Pasello, Federico Rea

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVES Induction therapy (IT) has gained popularity in recent years, becoming a standard of treatment in resectable lymph node-positive NSCLC. IT aims to downstage the disease (shrinkage of tumour and clearance of lymph node-metastases), clear distant micrometastases and prolong survival. Potential disadvantages are increased morbidity and/or mortality after surgery and risk of progression of disease that could have been initially resected. The purpose of this study was to evaluate the outcomes and prognostic factors in a series of patients with lymph node-positive NSCLC receiving IT followed by surgery. METHODS A total of 86 patients (75.6% males, median age 63 years) affected by NSCLC in clinical stage IIIA (n = 80) or IIIB (n = 6), with pathologically proven lymph node involvement, underwent platinum-based IT followed by surgery between 2000 and 2009. RESULTS Eighty (93%) patients received a median of 3 cycles of chemotherapy, and 6 (7%) underwent induction chemoradiotherapy. Response to IT was complete in 3.5%, partial in 59.3% and stable disease in 37.2% of patients. Postoperative morbidity and mortality were 25.6 and 2.3%, respectively. At pathological evaluation, 38.4% of patients had a downstaging of disease with a complete lymph node clearance in 31.4%. Median overall survival was 23 months (5-year survival 33%). Univariate analysis found clinical stage (P = 0.02), histology (P = 0.01), response to IT (P = 0.02) and type of intervention (P = 0.047) to have predictive roles in survival. A better but not significant survival was also found for pN0 vs pN+ (P = 0.22), downstaged tumours (P = 0.08) and left side (P = 0.06). On multivariate analysis, clinical response to neoadjuvant therapy (P = 0.01) and age (P = 0.03) were the only independent predictors of survival. CONCLUSIONS The use of IT for lymph node-positive NSCLC seems justified by low morbidity and/or mortality and good survival rates. Patients with response to IT showed greater benefit in the long term.

Original languageEnglish
Pages (from-to)256-262
Number of pages7
JournalInteractive Cardiovascular and Thoracic Surgery
Volume19
Issue number2
DOIs
Publication statusPublished - 2014

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Non-Small Cell Lung Carcinoma
Lymph Nodes
Survival
Therapeutics
Morbidity
Mortality
Neoplasm Micrometastasis
Neoadjuvant Therapy
Chemoradiotherapy
Platinum
Disease Progression
Neoplasms
Histology
Multivariate Analysis
Survival Rate
Neoplasm Metastasis
Drug Therapy

Keywords

  • Induction chemotherapy
  • Mediastinal nodal involvement
  • N2 non-small-cell lung cancer
  • Neoadjuvant therapy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Surgery
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Outcomes and prognostic factors of non-small-cell lung cancer with lymph node involvement treated with induction treatment and surgical resection. / Marulli, Giuseppe; Verderi, Enrico; Zuin, Andrea; Schiavon, Marco; Battistella, Lucia; Perissinotto, Egle; Romanello, Paola; Favaretto, Adolfo Gino; Pasello, Giulia; Rea, Federico.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 19, No. 2, 2014, p. 256-262.

Research output: Contribution to journalArticle

Marulli, Giuseppe ; Verderi, Enrico ; Zuin, Andrea ; Schiavon, Marco ; Battistella, Lucia ; Perissinotto, Egle ; Romanello, Paola ; Favaretto, Adolfo Gino ; Pasello, Giulia ; Rea, Federico. / Outcomes and prognostic factors of non-small-cell lung cancer with lymph node involvement treated with induction treatment and surgical resection. In: Interactive Cardiovascular and Thoracic Surgery. 2014 ; Vol. 19, No. 2. pp. 256-262.
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abstract = "OBJECTIVES Induction therapy (IT) has gained popularity in recent years, becoming a standard of treatment in resectable lymph node-positive NSCLC. IT aims to downstage the disease (shrinkage of tumour and clearance of lymph node-metastases), clear distant micrometastases and prolong survival. Potential disadvantages are increased morbidity and/or mortality after surgery and risk of progression of disease that could have been initially resected. The purpose of this study was to evaluate the outcomes and prognostic factors in a series of patients with lymph node-positive NSCLC receiving IT followed by surgery. METHODS A total of 86 patients (75.6{\%} males, median age 63 years) affected by NSCLC in clinical stage IIIA (n = 80) or IIIB (n = 6), with pathologically proven lymph node involvement, underwent platinum-based IT followed by surgery between 2000 and 2009. RESULTS Eighty (93{\%}) patients received a median of 3 cycles of chemotherapy, and 6 (7{\%}) underwent induction chemoradiotherapy. Response to IT was complete in 3.5{\%}, partial in 59.3{\%} and stable disease in 37.2{\%} of patients. Postoperative morbidity and mortality were 25.6 and 2.3{\%}, respectively. At pathological evaluation, 38.4{\%} of patients had a downstaging of disease with a complete lymph node clearance in 31.4{\%}. Median overall survival was 23 months (5-year survival 33{\%}). Univariate analysis found clinical stage (P = 0.02), histology (P = 0.01), response to IT (P = 0.02) and type of intervention (P = 0.047) to have predictive roles in survival. A better but not significant survival was also found for pN0 vs pN+ (P = 0.22), downstaged tumours (P = 0.08) and left side (P = 0.06). On multivariate analysis, clinical response to neoadjuvant therapy (P = 0.01) and age (P = 0.03) were the only independent predictors of survival. CONCLUSIONS The use of IT for lymph node-positive NSCLC seems justified by low morbidity and/or mortality and good survival rates. Patients with response to IT showed greater benefit in the long term.",
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author = "Giuseppe Marulli and Enrico Verderi and Andrea Zuin and Marco Schiavon and Lucia Battistella and Egle Perissinotto and Paola Romanello and Favaretto, {Adolfo Gino} and Giulia Pasello and Federico Rea",
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T1 - Outcomes and prognostic factors of non-small-cell lung cancer with lymph node involvement treated with induction treatment and surgical resection

AU - Marulli, Giuseppe

AU - Verderi, Enrico

AU - Zuin, Andrea

AU - Schiavon, Marco

AU - Battistella, Lucia

AU - Perissinotto, Egle

AU - Romanello, Paola

AU - Favaretto, Adolfo Gino

AU - Pasello, Giulia

AU - Rea, Federico

PY - 2014

Y1 - 2014

N2 - OBJECTIVES Induction therapy (IT) has gained popularity in recent years, becoming a standard of treatment in resectable lymph node-positive NSCLC. IT aims to downstage the disease (shrinkage of tumour and clearance of lymph node-metastases), clear distant micrometastases and prolong survival. Potential disadvantages are increased morbidity and/or mortality after surgery and risk of progression of disease that could have been initially resected. The purpose of this study was to evaluate the outcomes and prognostic factors in a series of patients with lymph node-positive NSCLC receiving IT followed by surgery. METHODS A total of 86 patients (75.6% males, median age 63 years) affected by NSCLC in clinical stage IIIA (n = 80) or IIIB (n = 6), with pathologically proven lymph node involvement, underwent platinum-based IT followed by surgery between 2000 and 2009. RESULTS Eighty (93%) patients received a median of 3 cycles of chemotherapy, and 6 (7%) underwent induction chemoradiotherapy. Response to IT was complete in 3.5%, partial in 59.3% and stable disease in 37.2% of patients. Postoperative morbidity and mortality were 25.6 and 2.3%, respectively. At pathological evaluation, 38.4% of patients had a downstaging of disease with a complete lymph node clearance in 31.4%. Median overall survival was 23 months (5-year survival 33%). Univariate analysis found clinical stage (P = 0.02), histology (P = 0.01), response to IT (P = 0.02) and type of intervention (P = 0.047) to have predictive roles in survival. A better but not significant survival was also found for pN0 vs pN+ (P = 0.22), downstaged tumours (P = 0.08) and left side (P = 0.06). On multivariate analysis, clinical response to neoadjuvant therapy (P = 0.01) and age (P = 0.03) were the only independent predictors of survival. CONCLUSIONS The use of IT for lymph node-positive NSCLC seems justified by low morbidity and/or mortality and good survival rates. Patients with response to IT showed greater benefit in the long term.

AB - OBJECTIVES Induction therapy (IT) has gained popularity in recent years, becoming a standard of treatment in resectable lymph node-positive NSCLC. IT aims to downstage the disease (shrinkage of tumour and clearance of lymph node-metastases), clear distant micrometastases and prolong survival. Potential disadvantages are increased morbidity and/or mortality after surgery and risk of progression of disease that could have been initially resected. The purpose of this study was to evaluate the outcomes and prognostic factors in a series of patients with lymph node-positive NSCLC receiving IT followed by surgery. METHODS A total of 86 patients (75.6% males, median age 63 years) affected by NSCLC in clinical stage IIIA (n = 80) or IIIB (n = 6), with pathologically proven lymph node involvement, underwent platinum-based IT followed by surgery between 2000 and 2009. RESULTS Eighty (93%) patients received a median of 3 cycles of chemotherapy, and 6 (7%) underwent induction chemoradiotherapy. Response to IT was complete in 3.5%, partial in 59.3% and stable disease in 37.2% of patients. Postoperative morbidity and mortality were 25.6 and 2.3%, respectively. At pathological evaluation, 38.4% of patients had a downstaging of disease with a complete lymph node clearance in 31.4%. Median overall survival was 23 months (5-year survival 33%). Univariate analysis found clinical stage (P = 0.02), histology (P = 0.01), response to IT (P = 0.02) and type of intervention (P = 0.047) to have predictive roles in survival. A better but not significant survival was also found for pN0 vs pN+ (P = 0.22), downstaged tumours (P = 0.08) and left side (P = 0.06). On multivariate analysis, clinical response to neoadjuvant therapy (P = 0.01) and age (P = 0.03) were the only independent predictors of survival. CONCLUSIONS The use of IT for lymph node-positive NSCLC seems justified by low morbidity and/or mortality and good survival rates. Patients with response to IT showed greater benefit in the long term.

KW - Induction chemotherapy

KW - Mediastinal nodal involvement

KW - N2 non-small-cell lung cancer

KW - Neoadjuvant therapy

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