Surgery for patients with persistent pathological N2 IIIA stage in non-small-cell lung cancer after induction radio-chemotherapy: The microscopic seed of doubt

Elisa Meacci, Alfredo Cesario, Giacomo Cusumano, Filippo Lococo, Rolando D'Angelillo, Valentina Dall'Armi, Stefano Margaritora, Pierluigi Granone

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: The surgical treatment of residual N2 disease following induction radio-chemotherapy (IT) for locally advanced cIIIA-N2 non-small-cell lung cancer (NSCLC) is still debated. The long-term results after resection in a pN2 series are at the focus of this study. Methods: From January 1992 to December 2008, 161 consecutive pathologically proven Stage IIIA-N2 NSCLC patients underwent IT. Among these, 40 pN2s were included in this retrospective analysis. The associations between the mortality and the disease-free status with potential risk factors were explored by means of the Kaplan-Meier and Cox regression analysis. Results: Mean age and male/female ratio were 58.7 ± 9.7 years and 36/4, respectively. Twelve patients (30%) showed a clinical partial response and 28 (70%) showed stable disease. There was one (3%) perioperative death and four (10%) major complications. In the total group, the 3- and 5-year survival rates were 24.2% and 19.3%, respectively. The Cox regression analysis suggested that the macroscopic pN2 status proved to be a negative prognostic factor (hazard ratio (HR). = 2.8, confidence interval (CI) 95%: 1.1-7.3; p = 0.04). The recurrence rate flattened at 30.8% at the 3rd year. Furthermore, the bilobectomy-pneumonectomy group had a risk of relapse 6.9 times higher than the lobectomy group (CI 95%: 2.5-18.8; p<0.001). Conclusions: The persistence of disease at the N2 level after IT and surgery for cIIIa-N2 NSCLC does not exclude favorable outcome after resection, in particular in those patients with minor residual disease.

Original languageEnglish
Pages (from-to)656-663
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume40
Issue number3
DOIs
Publication statusPublished - Sep 2011

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Induction Chemotherapy
Radio
Non-Small Cell Lung Carcinoma
Seeds
Regression Analysis
Confidence Intervals
Recurrence
Pneumonectomy
Survival Rate
Mortality

Keywords

  • Induction therapy
  • NSCLC
  • Radiotherapy
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Surgery for patients with persistent pathological N2 IIIA stage in non-small-cell lung cancer after induction radio-chemotherapy : The microscopic seed of doubt. / Meacci, Elisa; Cesario, Alfredo; Cusumano, Giacomo; Lococo, Filippo; D'Angelillo, Rolando; Dall'Armi, Valentina; Margaritora, Stefano; Granone, Pierluigi.

In: European Journal of Cardio-thoracic Surgery, Vol. 40, No. 3, 09.2011, p. 656-663.

Research output: Contribution to journalArticle

Meacci, Elisa ; Cesario, Alfredo ; Cusumano, Giacomo ; Lococo, Filippo ; D'Angelillo, Rolando ; Dall'Armi, Valentina ; Margaritora, Stefano ; Granone, Pierluigi. / Surgery for patients with persistent pathological N2 IIIA stage in non-small-cell lung cancer after induction radio-chemotherapy : The microscopic seed of doubt. In: European Journal of Cardio-thoracic Surgery. 2011 ; Vol. 40, No. 3. pp. 656-663.
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abstract = "Objective: The surgical treatment of residual N2 disease following induction radio-chemotherapy (IT) for locally advanced cIIIA-N2 non-small-cell lung cancer (NSCLC) is still debated. The long-term results after resection in a pN2 series are at the focus of this study. Methods: From January 1992 to December 2008, 161 consecutive pathologically proven Stage IIIA-N2 NSCLC patients underwent IT. Among these, 40 pN2s were included in this retrospective analysis. The associations between the mortality and the disease-free status with potential risk factors were explored by means of the Kaplan-Meier and Cox regression analysis. Results: Mean age and male/female ratio were 58.7 ± 9.7 years and 36/4, respectively. Twelve patients (30{\%}) showed a clinical partial response and 28 (70{\%}) showed stable disease. There was one (3{\%}) perioperative death and four (10{\%}) major complications. In the total group, the 3- and 5-year survival rates were 24.2{\%} and 19.3{\%}, respectively. The Cox regression analysis suggested that the macroscopic pN2 status proved to be a negative prognostic factor (hazard ratio (HR). = 2.8, confidence interval (CI) 95{\%}: 1.1-7.3; p = 0.04). The recurrence rate flattened at 30.8{\%} at the 3rd year. Furthermore, the bilobectomy-pneumonectomy group had a risk of relapse 6.9 times higher than the lobectomy group (CI 95{\%}: 2.5-18.8; p<0.001). Conclusions: The persistence of disease at the N2 level after IT and surgery for cIIIa-N2 NSCLC does not exclude favorable outcome after resection, in particular in those patients with minor residual disease.",
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T1 - Surgery for patients with persistent pathological N2 IIIA stage in non-small-cell lung cancer after induction radio-chemotherapy

T2 - The microscopic seed of doubt

AU - Meacci, Elisa

AU - Cesario, Alfredo

AU - Cusumano, Giacomo

AU - Lococo, Filippo

AU - D'Angelillo, Rolando

AU - Dall'Armi, Valentina

AU - Margaritora, Stefano

AU - Granone, Pierluigi

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N2 - Objective: The surgical treatment of residual N2 disease following induction radio-chemotherapy (IT) for locally advanced cIIIA-N2 non-small-cell lung cancer (NSCLC) is still debated. The long-term results after resection in a pN2 series are at the focus of this study. Methods: From January 1992 to December 2008, 161 consecutive pathologically proven Stage IIIA-N2 NSCLC patients underwent IT. Among these, 40 pN2s were included in this retrospective analysis. The associations between the mortality and the disease-free status with potential risk factors were explored by means of the Kaplan-Meier and Cox regression analysis. Results: Mean age and male/female ratio were 58.7 ± 9.7 years and 36/4, respectively. Twelve patients (30%) showed a clinical partial response and 28 (70%) showed stable disease. There was one (3%) perioperative death and four (10%) major complications. In the total group, the 3- and 5-year survival rates were 24.2% and 19.3%, respectively. The Cox regression analysis suggested that the macroscopic pN2 status proved to be a negative prognostic factor (hazard ratio (HR). = 2.8, confidence interval (CI) 95%: 1.1-7.3; p = 0.04). The recurrence rate flattened at 30.8% at the 3rd year. Furthermore, the bilobectomy-pneumonectomy group had a risk of relapse 6.9 times higher than the lobectomy group (CI 95%: 2.5-18.8; p<0.001). Conclusions: The persistence of disease at the N2 level after IT and surgery for cIIIa-N2 NSCLC does not exclude favorable outcome after resection, in particular in those patients with minor residual disease.

AB - Objective: The surgical treatment of residual N2 disease following induction radio-chemotherapy (IT) for locally advanced cIIIA-N2 non-small-cell lung cancer (NSCLC) is still debated. The long-term results after resection in a pN2 series are at the focus of this study. Methods: From January 1992 to December 2008, 161 consecutive pathologically proven Stage IIIA-N2 NSCLC patients underwent IT. Among these, 40 pN2s were included in this retrospective analysis. The associations between the mortality and the disease-free status with potential risk factors were explored by means of the Kaplan-Meier and Cox regression analysis. Results: Mean age and male/female ratio were 58.7 ± 9.7 years and 36/4, respectively. Twelve patients (30%) showed a clinical partial response and 28 (70%) showed stable disease. There was one (3%) perioperative death and four (10%) major complications. In the total group, the 3- and 5-year survival rates were 24.2% and 19.3%, respectively. The Cox regression analysis suggested that the macroscopic pN2 status proved to be a negative prognostic factor (hazard ratio (HR). = 2.8, confidence interval (CI) 95%: 1.1-7.3; p = 0.04). The recurrence rate flattened at 30.8% at the 3rd year. Furthermore, the bilobectomy-pneumonectomy group had a risk of relapse 6.9 times higher than the lobectomy group (CI 95%: 2.5-18.8; p<0.001). Conclusions: The persistence of disease at the N2 level after IT and surgery for cIIIa-N2 NSCLC does not exclude favorable outcome after resection, in particular in those patients with minor residual disease.

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