Journal
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Volume 28, Issue 4, Pages 629-634Publisher
OXFORD UNIV PRESS INC
DOI: 10.1016/j.ejcts.2005.06.018
Keywords
non-small-cell lung cancer; induction therapy; surgery; chemotherapy; downstaging; vascular invasion
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Objective: Induction Therapy (IT) before surgery emerged as a widely used strategy for IIIAN2 and selected IIIB NSCLC patients. However, IT is associated with a possible increase in postoperative complications. Consequently, selection of patients with the best chances to benefit from combined treatment is mandatory. Methods: Study recorded demographics, treatment and outcome of consecutive patients treated with IT plus surgery for IIIAN2 or IIIB NSCLC. Survival was analysed by Kaplan-Meier and prognostic factors were analysed by log-rank and Cox regression. Results: From 1993 to 2003, 155 patients (IIIAN2=95/IIIB=60) were treated. Complete resection was associated with a significant prolonged median survival both for IIIAN2 (20 vs 16 months, P=0.05) and IIIB (20 vs 15 months, P=0.02) patients. A tower risk of death for IIIAN2 patients was independently associated with postoperative mediastinal lymph node clearance (HR=0.45, 95%Cl [0.25-0.81], P=0.009) and absence of postoperative complication (HR=0.54, 95%Cl [0.31-0.93], P=0.02). Absence of blood vessel invasion only was identified as an independent predictor of a lower risk of death (HR=0.27, 95%Cl [0.12-0.59], P=0.01) for stage IIIB patients. Conclusions: Besides similarities as the rote of a complete R0 resection, treatment-related factors influence outcome of IIIAN2 patients white disease-related factors prevail on survival of IIIB patients, in whom the benefit of IT is unclear. (c) 2005 Published by Elsevier B.V.
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