Prognostic factors in neoadjuvant treatment followed by surgery in stage IIIA-N2 non-small cell lung cancer: a multi-institutional study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society)

• F. Couñago ^[1] ; S. Montemuiño ^[2] ; M. Martin ^[3] ; B. Taboada ^[15] ; P. Calvo-Crespo ^[15] ; M. P. Samper-Ots ^[4] ; P. Alcántara ^[5] ; J. Corona ^[5] ; J. L. López-Guerra ^[6] ; M. Murcia-Mejía ^[7] ; M. López-Mata ^[8] ; J. Jové-Teixidó ^[16] ; M. Chust ^[9] ; V. Díaz-Díaz ^[10] ; L. de Ingunza-Barón ^[10] ; T. García-Cañibano ^[2] ; M. L. Couselo ^[11] ; E. del Cerro ^[1] ; J. Moradiellos ^[1] ; S. Amor ^[1] ; A. Varela ^[1] ; M. M. Puertas ^[12] ; I. J. Thuissard ^[13] ; D. Sanz-Rosa ^[13] ; N. R. de Dios ^[14]
  1. [1] Hospital Universitario Quirónsalud Madrid

     Hospital Universitario Quirónsalud Madrid

     Madrid, España

     
  2. [2] Hospital de Fuenlabrada

     Hospital de Fuenlabrada

     Fuenlabrada, España

     
  3. [3] Hospital Ramón y Cajal

     Hospital Ramón y Cajal

     Madrid, España

     
  4. [4] Hospital Universitario Rey Juan Carlos

     Hospital Universitario Rey Juan Carlos

     Móstoles, España

     
  5. [5] Hospital Clínico San Carlos de Madrid

     Hospital Clínico San Carlos de Madrid

     Madrid, España

     
  6. [6] Hospital Universitario Virgen del Rocío

     Hospital Universitario Virgen del Rocío

     Sevilla, España

     
  7. [7] Hospital Universitari Sant Joan de Reus

     Hospital Universitari Sant Joan de Reus

     Reus, España

     
  8. [8] Hospital Clínico Universitario Lozano Blesa

     Hospital Clínico Universitario Lozano Blesa

     Zaragoza, España

     
  9. [9] Instituto Valenciano de Oncologia

     Instituto Valenciano de Oncologia

     Valencia, España

     
  10. [10] Hospital Universitario Puerta del Mar

      Hospital Universitario Puerta del Mar

      Cádiz, España

      
  11. [11] Hospital Central de la Defensa

      Hospital Central de la Defensa

      Madrid, España

      
  12. [12] Hospital Miguel Servet

      Hospital Miguel Servet

      Zaragoza, España

      
  13. [13] Universidad Europea (México)

      Universidad Europea (México)

      México

      
  14. [14] Hospital del Mar

      Hospital del Mar

      Barcelona, España

      
  15. [15] Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela
  16. [16] Department of Radiation Oncology, Hospital Germans Trias i Pujol. Badalona

  Mostrar afiliaciones +
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 21, Nº. 6, 2019, págs. 735-744
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Purpose To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC).

    Methods A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method and compared using the log-rank test. Cox regression analysis was performed.

    Results Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5 months (5–128 months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0–pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen.

    Conclusions In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patients.