One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: An uncertain balance between risks and benefits
| Autor: | Delphine Trousse, Philippe Astoul, Sadio Yena, Roger Giudicelli, Christophe Doddoli, Pierre Fuentes, Stéphane Robitail, Fabrice Barlesi, Pascal Thomas |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Lung Neoplasms medicine.medical_treatment Antineoplastic Agents Platinum Compounds Pneumonectomy Carcinoma Non-Small-Cell Lung medicine Humans Lung cancer Neoadjuvant therapy Aged Neoplasm Staging Retrospective Studies business.industry Retrospective cohort study Middle Aged medicine.disease Combined Modality Therapy Survival Analysis Neoadjuvant Therapy Confidence interval Surgery Regimen Treatment Outcome Relative risk Female business Cardiology and Cardiovascular Medicine Brain metastasis |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 130(2):416-425 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2004.11.022 |
| Popis: | ObjectiveWe sought to assess postoperative outcome after pneumonectomy after neoadjuvant therapy in patients with non-small cell lung cancer.MethodsThis retrospective study included 100 patients treated from January 1989 through December 2003 for a primary lung cancer in whom pneumonectomy had been performed after an induction treatment. Surgical intervention had not been considered initially for the following reasons: N2 disease (stage IIIA, n = 79), doubtful resectability (stage IIIB [T4, N0], n = 19), and M1 disease (stage IV [T2, N0, M1, solitary brain metastasis], n = 2). All patients received a 2-drug platinum-based regimen with a median of 2.5 cycles (range, 2–4 cycles), and 30 had associated radiotherapy (30–45 Gy).ResultsThere were 55 right and 45 left resections. Overall 30-day and 90-day mortality rates were 12% and 21%, respectively. At multivariate analysis, one inde- pendent prognostic factor entered the model to predict 30-day mortality: postoperative cardiovascular event (relative risk, 45.7; 95% confidence interval, 3.7–226.7; P = .001). Four variables predicted 90-day mortality: age of more than 60 years (relative risk, 5.06; 95% confidence interval, 1.47–17.48; P = .01), male sex (relative risk, 8.25; 95% confidence interval, 1.01–67.34; P = .049), postoperative respiratory event (relative risk, 3.64; 95% confidence interval, 1.14–9.37; P = .007), and postoperative cardiovascular event (relative risk, 7.84; 95% confidence interval, 3.12–19.71; P < .001). Estimated overall survivals in 90-day survivors were 35% (range, 29%-41%) and 25% (range, 19.3%-30.7%) at 3 and 5 years, respectively. At multivariate analysis, one independent prognostic factor entered the model: pathologic stage III-IV residual disease (relative risk, 1.89; 95% confidence interval, 1.09–3.26; P = .022).ConclusionsPneumonectomy after induction therapy is a high-risk procedure, the survival benefit of which appears uncertain. |
| Databáze: | OpenAIRE |
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