O-033PATIENTS WITH STAGE IIIA (N2) NON-SMALL-CELL LUNG CANCER SELECTED FOR NEOADJUVANT CHEMORADIATION AND SURGERY HAVE IMPROVED SURVIVAL COMPARED TO PATIENTS TREATED WITH DEFINITIVE CHEMORADIATION

• Published in: Interactive cardiovascular and thoracic surgery 2014-06, Vol.18 (suppl_1), p.S9-S9
• Main Authors: Darling, Gail, Li, F., Patsios, D., Massey, C., Hope, A., Keshavjee, S., Waddell, T., Bezjak, A., Shepherd, F., De Perrot, M., Pierre, A., Yasufuku, K., Cypel, M.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu167.33

Objectives: The objective of this study was to compare survival in patients with stage IIIA (N2) non-small-cell lung cancer (NSCLC) selected for treatment with definitive chemoradiation who may have been operative candidates or chemoradiation followed by surgery in a centre with experience in surgery after chemoradiation. Methods: A retrospective analysis of patients with stage IIIA (N2) NSCLC treated with curative intent at a single centre between 1997 and 2007. Survival outcomes were analyzed using Cox proportional hazards model, log-rank test and Kaplan-Meier methodology. Time to recurrence was compared using the proportional subdistribution hazards regression model, Gray's test and cumulative incidence functions. Survival outcomes and recurrences were compared in regression models adjusting for age at diagnosis, cell type, ECOG status, gender and smoking history. Regression models adjusted for a measure of the likelihood of having surgery (the propensity score) were also determined. Results: Between 1997 and 2007, 199 patients with a median age of 61, were treated with chemoradiation followed by surgery (91) or chemoradiation (108). In the surgery group 71 (78%) had a lobectomy. Surgical patients were more likely to be younger (P = 0.045), female (P = 0.045), T1N2 (23% vs 19%) and less likely to be T3N2 (10% vs 20%). Surgical patients had decreased disease recurrence at any location (HR= 0.49; 95% CI 0.34-0.71, P = 0.0002), locoregional recurrence (HR= 0.52; 95% CI 0.2-0.84, P = 0.007), and increased time to distant recurrence (HR= 0.65; 95% CI 0.41-1.3, P = 0.07) with a median survival of 3.4 years compared to 1.7 years for the non-surgical patients (HR = 0.53, 95% CI 0.38-0.76, P = 0.0005). The propensity score adjusted for overall survival was 0.56 (95% CI 0.39-0.79, P = 0.001). Mortality was 6 (6.8%) in the surgery group and 3 (3.2%) in the nonsurgery group. Conclusions: For carefully selected patients with stage IIIA (N2) NSCLC, neoadjuvant chemoradiation followed by surgery offers prolonged survival and time to recurrence. Disclosure: No significant relationships.