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 |
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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 |
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