Long-term outcomes after lobectomy for non–small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis

Autor: Matthew G. Hartwig, Mark F. Berry, Thomas A. D'Amico, Michael S. Mulvihill, Brian C. Gulack, Xiaofei Wang, Chi-Fu Jeffrey Yang, Arvind Kumar
Rok vydání: 2016
Předmět:
Male
Lung Neoplasms
Time Factors
Databases
Factual
medicine.medical_treatment
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Cohort Studies
0302 clinical medicine
Carcinoma
Non-Small-Cell Lung
Cause of Death
Pneumonectomy
education.field_of_study
Lung cancer surgery
medicine.diagnostic_test
Mediastinum
Middle Aged
Treatment Outcome
Chemotherapy
Adjuvant
Lymphatic Metastasis
030220 oncology & carcinogenesis
Female
Radiology
Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Population
Disease-Free Survival
Perioperative Care
Statistics
Nonparametric
Article
03 medical and health sciences
medicine
Adjuvant therapy
Thoracoscopy
Humans
Neoplasm Invasiveness
Lung cancer
education
Aged
Neoplasm Staging
Retrospective Studies
business.industry
Retrospective cohort study
medicine.disease
Survival Analysis
Surgery
Radiation therapy
Lymph Nodes
business
Follow-Up Studies
Zdroj: The Journal of Thoracic and Cardiovascular Surgery. 151:1380-1388
ISSN: 0022-5223
Popis: There are few studies evaluating whether to proceed with planned resection when a patient with non-small cell lung cancer (NSCLC) unexpectedly is found to have N2 disease at the time of thoracoscopy or thoracotomy. To help guide management of this clinical scenario, we evaluated outcomes for patients who were upstaged to pN2 after lobectomy without induction therapy using the National Cancer Data Base (NCDB).Survival of NSCLC patients treated with lobectomy for clinically unsuspected mediastinal nodal disease (cT1-cT3 cN0-cN1, pN2 disease) from 1998-2006 in the NCDB was compared with "suspected" N2 disease patients (cT1-cT3 cN2) who were treated with chemotherapy with or without radiation followed by lobectomy, using matched analysis based on propensity scores.Unsuspected pN2 disease was found in 4.4% of patients (2047 out of 46,691) who underwent lobectomy as primary therapy for cT1-cT3 cN0-cN1 NSCLC. The 5-year survival was 42%, 36%, 21%, and 28% for patients who underwent adjuvant chemotherapy (n = 385), chemoradiation (n = 504), radiation (n = 300), and no adjuvant therapy (n = 858), respectively. Five-year survival of the entire unsuspected pN2 cohort was worse than survival of 2302 patients who were treated with lobectomy after induction therapy for clinical N2 disease (30% vs 40%; P.001), although no significant difference in 5-year survival was found in a matched-analysis of 655 patients from each group (37% vs 37%; P = .95).This population-based analysis suggests that, in the setting of unsuspected pN2 NSCLC, proceeding with lobectomy does not appear to compromise outcomes if adjuvant chemotherapy with or without radiation therapy can be administered following surgery.
Databáze: OpenAIRE
Externí odkaz: