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Prognostic factors and long term results of neo adjuvant therapy followed by surgery in stage IIIA N2 non-small cell lung cancer patients.

Li J, Dai CH, Shi SB, Chen P, Yu LC, Wu JR - Ann Thorac Med (2009)

Bottom Line: All patients received a platinum-based chemotherapy and 23 (29.1%) had an associated radiotherapy.Prognostic factors for survival on univariate analysis was clinical response (P = 0.032), complete resection (P = 0.002), pathologic tumor response ( P < 0.001), and lymph nodal down staging (P = 0.001).Multivariate analyses identified complete resection, pathologic tumor response and lymph nodal down staging as independent prognostic factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China. lijian541226@163.com

ABSTRACT

Background: Prognosis of stage IIIA N2 non-small cell lung cancer (NSCLC) remains poor despite the changes in therapeutic strategies.

Objectives: To assess long term results of neo adjuvant therapy followed by surgery for patients with stage IIIA N2 NSCLC and to analyze factors influencing survival.

Materials and methods: The methods adopted include: Retrospective review of medical records of 91 patients with stage IIIA N2 NSCLC, who received neo adjuvant therapy followed by surgery; collection of information on demographic information, staging procedure, preoperative therapy, clinical response, type of resection, pathologic response of tumor, status of lymph nodes and adjuvant chemotherapy; survival analysis by Kaplan-Meier and calculation of prognostic factors using log-rank and Cox regression model.

Results: All patients received a platinum-based chemotherapy and 23 (29.1%) had an associated radiotherapy. Eighty four patients underwent thoracotomy. Median survival was 26 months (95%CI, 22.6-30.8 months) with three and five year survival rates of 31.6 and 20.9%, respectively. Prognostic factors for survival on univariate analysis was clinical response (P = 0.032), complete resection (P = 0.002), pathologic tumor response ( P < 0.001), and lymph nodal down staging (P = 0.001). Multivariate analyses identified complete resection, pathologic tumor response and lymph nodal down staging as independent prognostic factors.

Conclusion: Survival of patients with stage IIIA N2 NSCLC who received neo adjuvant therapy is significantly influenced by clinical response, complete resection, pathologic tumor response, and lymph nodal down staging. These results can be helpful in guiding standard clinical practice and evaluating the outcome of neo adjuvant therapy followed by surgery in patients with stage IIIA N2 NSCLC.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival curve according to respone to neo adjuvant chemotherapy; (Complete response and partial response versus stable and progressive disease, log rank test: P = 0.032)
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Figure 0001: Kaplan-Meier survival curve according to respone to neo adjuvant chemotherapy; (Complete response and partial response versus stable and progressive disease, log rank test: P = 0.032)

Mentions: For the purposes of analysis, the squamous cell carcinoma patients were considered as one group, and the other patients who predominantly had ademocarcinoma were considered nonsquamous. The results of univariate analysis of prognostic factors for survival are shown in Table 2. Factors correlated with improved survival were clinical response (PR and CR), complete resection (R0), pathologic response of tumor (pCR and pPR), and lymph nodal down staging (N1 and N0). Patients who had clinical complete or partial response to neo adjuvant therapy had a 30-month median survival compared with 23 months for patients with stable disease and progressive disease [P = 0.032, Figure 1]. The patients with complete resection had a median survival of 30 months compared with 21 months for patients with incomplete resection [P = 0.002, Figure 2]. Pathologic complete and partial response was associated with 36 months median survival, compared with 23 months in patients with pathologic no change in surgical specimens [P < 0.001, Figure 3]. The median survival for patients with N1 and N0 disease was 37 months compared with 27 months for patients with residual N2 disease [P = 0.001, Figure 4]. Survival was not influenced by sex, initial clinical stage, histology, chemotherapy regimen, adjunction of radiotherapy, type of resection, and postoperative chemotherapy. Factors that demonstrated prognostic significance by univariate analysis were then examined in a multivariate analysis. Analysis of Cox regression model showed that extent of surgical resection (P = 0.001), pathologic response of tumor (P < 0.001), and lymph nodal down staging (P = 0.048) were independent prognostic factors [Table 3].


Prognostic factors and long term results of neo adjuvant therapy followed by surgery in stage IIIA N2 non-small cell lung cancer patients.

Li J, Dai CH, Shi SB, Chen P, Yu LC, Wu JR - Ann Thorac Med (2009)

Kaplan-Meier survival curve according to respone to neo adjuvant chemotherapy; (Complete response and partial response versus stable and progressive disease, log rank test: P = 0.032)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2801045&req=5

Figure 0001: Kaplan-Meier survival curve according to respone to neo adjuvant chemotherapy; (Complete response and partial response versus stable and progressive disease, log rank test: P = 0.032)
Mentions: For the purposes of analysis, the squamous cell carcinoma patients were considered as one group, and the other patients who predominantly had ademocarcinoma were considered nonsquamous. The results of univariate analysis of prognostic factors for survival are shown in Table 2. Factors correlated with improved survival were clinical response (PR and CR), complete resection (R0), pathologic response of tumor (pCR and pPR), and lymph nodal down staging (N1 and N0). Patients who had clinical complete or partial response to neo adjuvant therapy had a 30-month median survival compared with 23 months for patients with stable disease and progressive disease [P = 0.032, Figure 1]. The patients with complete resection had a median survival of 30 months compared with 21 months for patients with incomplete resection [P = 0.002, Figure 2]. Pathologic complete and partial response was associated with 36 months median survival, compared with 23 months in patients with pathologic no change in surgical specimens [P < 0.001, Figure 3]. The median survival for patients with N1 and N0 disease was 37 months compared with 27 months for patients with residual N2 disease [P = 0.001, Figure 4]. Survival was not influenced by sex, initial clinical stage, histology, chemotherapy regimen, adjunction of radiotherapy, type of resection, and postoperative chemotherapy. Factors that demonstrated prognostic significance by univariate analysis were then examined in a multivariate analysis. Analysis of Cox regression model showed that extent of surgical resection (P = 0.001), pathologic response of tumor (P < 0.001), and lymph nodal down staging (P = 0.048) were independent prognostic factors [Table 3].

Bottom Line: All patients received a platinum-based chemotherapy and 23 (29.1%) had an associated radiotherapy.Prognostic factors for survival on univariate analysis was clinical response (P = 0.032), complete resection (P = 0.002), pathologic tumor response ( P < 0.001), and lymph nodal down staging (P = 0.001).Multivariate analyses identified complete resection, pathologic tumor response and lymph nodal down staging as independent prognostic factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China. lijian541226@163.com

ABSTRACT

Background: Prognosis of stage IIIA N2 non-small cell lung cancer (NSCLC) remains poor despite the changes in therapeutic strategies.

Objectives: To assess long term results of neo adjuvant therapy followed by surgery for patients with stage IIIA N2 NSCLC and to analyze factors influencing survival.

Materials and methods: The methods adopted include: Retrospective review of medical records of 91 patients with stage IIIA N2 NSCLC, who received neo adjuvant therapy followed by surgery; collection of information on demographic information, staging procedure, preoperative therapy, clinical response, type of resection, pathologic response of tumor, status of lymph nodes and adjuvant chemotherapy; survival analysis by Kaplan-Meier and calculation of prognostic factors using log-rank and Cox regression model.

Results: All patients received a platinum-based chemotherapy and 23 (29.1%) had an associated radiotherapy. Eighty four patients underwent thoracotomy. Median survival was 26 months (95%CI, 22.6-30.8 months) with three and five year survival rates of 31.6 and 20.9%, respectively. Prognostic factors for survival on univariate analysis was clinical response (P = 0.032), complete resection (P = 0.002), pathologic tumor response ( P < 0.001), and lymph nodal down staging (P = 0.001). Multivariate analyses identified complete resection, pathologic tumor response and lymph nodal down staging as independent prognostic factors.

Conclusion: Survival of patients with stage IIIA N2 NSCLC who received neo adjuvant therapy is significantly influenced by clinical response, complete resection, pathologic tumor response, and lymph nodal down staging. These results can be helpful in guiding standard clinical practice and evaluating the outcome of neo adjuvant therapy followed by surgery in patients with stage IIIA N2 NSCLC.

No MeSH data available.


Related in: MedlinePlus