Significantly favourable outcome for patients with non-small-cell lung cancer stage IIIA/IIIB and single-station persistent N2 (skip or additionally N1) disease after multimodality treatment. (9th August 2021)

• Record Type: Journal Article
• Authors: Stamatis, Georgios; Müller, Stefanie; Weinreich, Gerhard; Schwarz, Birte; Eberhardt, Wilfried; Pöttgen, Christoph; Aigner, Clemens
• Is Part Of: European journal of cardio-thoracic surgery. Volume 61:Number 2(2022)
• Page Start: 269
• Page End: 276
• Publication Date: 2021-08-09
• Subjects: Multimodality treatment in stage III non-small-cell lung cancer -- Single ypN2 (skip) -- Single ypN2 and N1 disease -- Multiple ypN2 nodes in final histology; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezab372
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: Persistent lymph nodes infiltration after neoadjuvant treatment remains a controversial topic in the treatment of stage III non-small-cell lung cancer (NSCLC). The aim of this study is to identify subgroups with persistent N2 disease, who could experience survival benefit from the addition of surgery. METHODS: A retrospective mono-institutional study was conducted to analyse all patients with a final histopathology of NSCLC and persistent mediastinal disease after induction chemotherapy or chemoradiotherapy and surgery from January 1998 to June 2015. RESULTS: A total of 145 patients (93 men, 52 women) fulfilled the inclusion criteria. The median age was 60 years (range 38–78). A total of 82 (56.5%) patients received a lobectomy, 48 (33.1%) a pneumonectomy, 11 (7.6%) a bilobectomy and 4 (2.6%) an anatomical segmentectomy; 128 (88.3%) were completely resected (R0). Operative mortality was 2.6% (4 patients), and morbidity was 35.2% (51 patients). Overall survival at 5 years was 47.3% ( n = 19) for single N2 (skip), 30.2% ( n = 16) for single N2 and N1 lymph nodes and under 5% ( n = 1) for multiple mediastinal stations disease. Overall survival at 5 years after lobectomy/bilobectomy was not statistically different than after pneumonectomy (33.5% vs 20.5%, P = 0.082). Disease-free survival at 5 years was 30.6% ( n = 6) for ypN2a1, 23.4% ( n = 7) for ypN2a2 and under 5% ( n = 1) for ypN2b status. CONCLUSIONS: Lobectomy or bilobectomy has to be taken into account as a potentially curative option with promising long-term results for patients after induction treatment and persistent single-station N2 involvement (skip or additionally N1 status). Trial registry number: 14-6138-BO. Abstract : For patients with locally advanced stage III non-small-cell lung cancer (NSCLC), multimodality treatment remains the standard of care [1, 2].