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The Significance of Upfront Knowledge of N2 Disease in Non-small Cell Lung Cancer
Background Previous literature suggests that patients with non-small cell lung cancer (NSCLC) and unsuspected N2 disease (cN0, pN2) represent a distinct subgroup associated with improved overall survival compared to patients with N2 disease identified prior to resection (cN2, pN2). Methods Retrospec...
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| Published in: | World journal of surgery 2018, Vol.42 (1), p.161-171 |
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| container_end_page | 171 |
| container_issue | 1 |
| container_start_page | 161 |
| container_title | World journal of surgery |
| container_volume | 42 |
| creator | Thomas, Daniel C. Arnold, Brian N. Rosen, Joshua E. Salazar, Michelle C. Detterbeck, Frank C. Blasberg, Justin D. Boffa, Daniel J. Kim, Anthony W. |
| description | Background
Previous literature suggests that patients with non-small cell lung cancer (NSCLC) and unsuspected N2 disease (cN0, pN2) represent a distinct subgroup associated with improved overall survival compared to patients with N2 disease identified prior to resection (cN2, pN2).
Methods
Retrospective analysis of the National Cancer Database of patients from 2004 to 2011 with cN0 and cN2 status found to be pathologic stage III-N2 NSCLC after surgical resection. Comparison of 5-year survival of patients with unsuspected N2 disease versus those with known N2 disease after surgical resection using Kaplan–Meier analysis was made. The independent effect of unsuspected N2 disease on mortality was analyzed using multivariate analysis.
Results
A total of 3271 patients with pathologic stage III-N2 NSCLC underwent curative intent surgical resection with or without adjuvant chemotherapy or chemotherapy and radiation. Unsuspected N2 disease was identified in 48% of patients. Patients with unsuspected N2 disease were more likely to have T1 tumors (37 vs. 32%,
p
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| doi_str_mv | 10.1007/s00268-017-4165-6 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1928506912</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1928506912</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4229-c4af8fa302f0124b773a7b747c73a491ed0375c43b8c56d8c1b203fcb4cbbf9c3</originalsourceid><addsrcrecordid>eNqFkF1LHDEUhoNUdLX-gN5IoDe9mXryMcnkUreuti6W4i69DJlsso7MZtbEQfbfm-1oEUG8OTmE5zm8vAh9IfCdAMiTBEBFVQCRBSeiLMQOGhHOaEEZZZ_QCJjgeSdsHx2kdAcZFCD20D6tpFJQ8RH6M7t1-KZZhsY31gTrcOfxfO1jFx7wVegeW7dY_vu8pvhHk5xJDjcBX3ehSCvTtnjs8pj2YYnHWz9-RrvetMkdPb-HaD45n40vi-nvi5_j02lhOaUqT-MrbxhQD4TyWkpmZC25tHnhirgFMFlazurKlmJRWVJTYN7W3Na1V5Ydom_D3XXs7nuXHvSqSTaHMcF1fdJE0aoEoQjN6Nc36F3Xx5DTZUoqKSUVkCkyUDZ2KUXn9To2KxM3moDe9q2HvnWuUW_71iI7x8-X-3rlFv-Nl4IzoAbgsWnd5uOL-u-vm7MJVKVQ2aWDm7IWli6-iv1uoifE-5lt</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1979777260</pqid></control><display><type>article</type><title>The Significance of Upfront Knowledge of N2 Disease in Non-small Cell Lung Cancer</title><source>Springer Nature</source><creator>Thomas, Daniel C. ; Arnold, Brian N. ; Rosen, Joshua E. ; Salazar, Michelle C. ; Detterbeck, Frank C. ; Blasberg, Justin D. ; Boffa, Daniel J. ; Kim, Anthony W.</creator><creatorcontrib>Thomas, Daniel C. ; Arnold, Brian N. ; Rosen, Joshua E. ; Salazar, Michelle C. ; Detterbeck, Frank C. ; Blasberg, Justin D. ; Boffa, Daniel J. ; Kim, Anthony W.</creatorcontrib><description>Background
Previous literature suggests that patients with non-small cell lung cancer (NSCLC) and unsuspected N2 disease (cN0, pN2) represent a distinct subgroup associated with improved overall survival compared to patients with N2 disease identified prior to resection (cN2, pN2).
Methods
Retrospective analysis of the National Cancer Database of patients from 2004 to 2011 with cN0 and cN2 status found to be pathologic stage III-N2 NSCLC after surgical resection. Comparison of 5-year survival of patients with unsuspected N2 disease versus those with known N2 disease after surgical resection using Kaplan–Meier analysis was made. The independent effect of unsuspected N2 disease on mortality was analyzed using multivariate analysis.
Results
A total of 3271 patients with pathologic stage III-N2 NSCLC underwent curative intent surgical resection with or without adjuvant chemotherapy or chemotherapy and radiation. Unsuspected N2 disease was identified in 48% of patients. Patients with unsuspected N2 disease were more likely to have T1 tumors (37 vs. 32%,
p
< 0.001). Unsuspected N2 disease did not impact 5-year overall survival compared with known N2 when adjuvant therapy was utilized (40 vs. 37%,
p
= 0.167). Multivariate analysis identified older age, higher comorbidity score, and treatment with surgery alone as independent risk factors for mortality. The presence of unsuspected N2 disease was not significant in this model.
Conclusions
The findings of this study suggest that unsuspected N2 disease is associated with equivalent 5-year survival compared to cN2 disease when adjuvant therapy is employed. These results support the use of adjuvant chemotherapy and radiation therapy when confronted with unsuspected N2 disease after surgical resection for stage IIIA-NSCLC.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-017-4165-6</identifier><identifier>PMID: 28799084</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Cancer ; Cancer therapies ; Cardiac Surgery ; Chemotherapy ; General Surgery ; Lung cancer ; Lung diseases ; Medicine ; Medicine & Public Health ; Mortality ; Multivariate analysis ; Non-small cell lung carcinoma ; Original Scientific Report ; Patients ; Radiation ; Radiation therapy ; Risk analysis ; Risk factors ; Surgery ; Survival ; Thoracic Surgery ; Tumors ; Vascular Surgery</subject><ispartof>World journal of surgery, 2018, Vol.42 (1), p.161-171</ispartof><rights>Société Internationale de Chirurgie 2017</rights><rights>2018 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>World Journal of Surgery is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4229-c4af8fa302f0124b773a7b747c73a491ed0375c43b8c56d8c1b203fcb4cbbf9c3</citedby><cites>FETCH-LOGICAL-c4229-c4af8fa302f0124b773a7b747c73a491ed0375c43b8c56d8c1b203fcb4cbbf9c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28799084$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thomas, Daniel C.</creatorcontrib><creatorcontrib>Arnold, Brian N.</creatorcontrib><creatorcontrib>Rosen, Joshua E.</creatorcontrib><creatorcontrib>Salazar, Michelle C.</creatorcontrib><creatorcontrib>Detterbeck, Frank C.</creatorcontrib><creatorcontrib>Blasberg, Justin D.</creatorcontrib><creatorcontrib>Boffa, Daniel J.</creatorcontrib><creatorcontrib>Kim, Anthony W.</creatorcontrib><title>The Significance of Upfront Knowledge of N2 Disease in Non-small Cell Lung Cancer</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Previous literature suggests that patients with non-small cell lung cancer (NSCLC) and unsuspected N2 disease (cN0, pN2) represent a distinct subgroup associated with improved overall survival compared to patients with N2 disease identified prior to resection (cN2, pN2).
Methods
Retrospective analysis of the National Cancer Database of patients from 2004 to 2011 with cN0 and cN2 status found to be pathologic stage III-N2 NSCLC after surgical resection. Comparison of 5-year survival of patients with unsuspected N2 disease versus those with known N2 disease after surgical resection using Kaplan–Meier analysis was made. The independent effect of unsuspected N2 disease on mortality was analyzed using multivariate analysis.
Results
A total of 3271 patients with pathologic stage III-N2 NSCLC underwent curative intent surgical resection with or without adjuvant chemotherapy or chemotherapy and radiation. Unsuspected N2 disease was identified in 48% of patients. Patients with unsuspected N2 disease were more likely to have T1 tumors (37 vs. 32%,
p
< 0.001). Unsuspected N2 disease did not impact 5-year overall survival compared with known N2 when adjuvant therapy was utilized (40 vs. 37%,
p
= 0.167). Multivariate analysis identified older age, higher comorbidity score, and treatment with surgery alone as independent risk factors for mortality. The presence of unsuspected N2 disease was not significant in this model.
Conclusions
The findings of this study suggest that unsuspected N2 disease is associated with equivalent 5-year survival compared to cN2 disease when adjuvant therapy is employed. These results support the use of adjuvant chemotherapy and radiation therapy when confronted with unsuspected N2 disease after surgical resection for stage IIIA-NSCLC.</description><subject>Abdominal Surgery</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Cardiac Surgery</subject><subject>Chemotherapy</subject><subject>General Surgery</subject><subject>Lung cancer</subject><subject>Lung diseases</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Non-small cell lung carcinoma</subject><subject>Original Scientific Report</subject><subject>Patients</subject><subject>Radiation</subject><subject>Radiation therapy</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Survival</subject><subject>Thoracic Surgery</subject><subject>Tumors</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNqFkF1LHDEUhoNUdLX-gN5IoDe9mXryMcnkUreuti6W4i69DJlsso7MZtbEQfbfm-1oEUG8OTmE5zm8vAh9IfCdAMiTBEBFVQCRBSeiLMQOGhHOaEEZZZ_QCJjgeSdsHx2kdAcZFCD20D6tpFJQ8RH6M7t1-KZZhsY31gTrcOfxfO1jFx7wVegeW7dY_vu8pvhHk5xJDjcBX3ehSCvTtnjs8pj2YYnHWz9-RrvetMkdPb-HaD45n40vi-nvi5_j02lhOaUqT-MrbxhQD4TyWkpmZC25tHnhirgFMFlazurKlmJRWVJTYN7W3Na1V5Ydom_D3XXs7nuXHvSqSTaHMcF1fdJE0aoEoQjN6Nc36F3Xx5DTZUoqKSUVkCkyUDZ2KUXn9To2KxM3moDe9q2HvnWuUW_71iI7x8-X-3rlFv-Nl4IzoAbgsWnd5uOL-u-vm7MJVKVQ2aWDm7IWli6-iv1uoifE-5lt</recordid><startdate>2018</startdate><enddate>2018</enddate><creator>Thomas, Daniel C.</creator><creator>Arnold, Brian N.</creator><creator>Rosen, Joshua E.</creator><creator>Salazar, Michelle C.</creator><creator>Detterbeck, Frank C.</creator><creator>Blasberg, Justin D.</creator><creator>Boffa, Daniel J.</creator><creator>Kim, Anthony W.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>2018</creationdate><title>The Significance of Upfront Knowledge of N2 Disease in Non-small Cell Lung Cancer</title><author>Thomas, Daniel C. ; Arnold, Brian N. ; Rosen, Joshua E. ; Salazar, Michelle C. ; Detterbeck, Frank C. ; Blasberg, Justin D. ; Boffa, Daniel J. ; Kim, Anthony W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4229-c4af8fa302f0124b773a7b747c73a491ed0375c43b8c56d8c1b203fcb4cbbf9c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdominal Surgery</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Cardiac Surgery</topic><topic>Chemotherapy</topic><topic>General Surgery</topic><topic>Lung cancer</topic><topic>Lung diseases</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Non-small cell lung carcinoma</topic><topic>Original Scientific Report</topic><topic>Patients</topic><topic>Radiation</topic><topic>Radiation therapy</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Surgery</topic><topic>Survival</topic><topic>Thoracic Surgery</topic><topic>Tumors</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thomas, Daniel C.</creatorcontrib><creatorcontrib>Arnold, Brian N.</creatorcontrib><creatorcontrib>Rosen, Joshua E.</creatorcontrib><creatorcontrib>Salazar, Michelle C.</creatorcontrib><creatorcontrib>Detterbeck, Frank C.</creatorcontrib><creatorcontrib>Blasberg, Justin D.</creatorcontrib><creatorcontrib>Boffa, Daniel J.</creatorcontrib><creatorcontrib>Kim, Anthony W.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thomas, Daniel C.</au><au>Arnold, Brian N.</au><au>Rosen, Joshua E.</au><au>Salazar, Michelle C.</au><au>Detterbeck, Frank C.</au><au>Blasberg, Justin D.</au><au>Boffa, Daniel J.</au><au>Kim, Anthony W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Significance of Upfront Knowledge of N2 Disease in Non-small Cell Lung Cancer</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2018</date><risdate>2018</risdate><volume>42</volume><issue>1</issue><spage>161</spage><epage>171</epage><pages>161-171</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
Previous literature suggests that patients with non-small cell lung cancer (NSCLC) and unsuspected N2 disease (cN0, pN2) represent a distinct subgroup associated with improved overall survival compared to patients with N2 disease identified prior to resection (cN2, pN2).
Methods
Retrospective analysis of the National Cancer Database of patients from 2004 to 2011 with cN0 and cN2 status found to be pathologic stage III-N2 NSCLC after surgical resection. Comparison of 5-year survival of patients with unsuspected N2 disease versus those with known N2 disease after surgical resection using Kaplan–Meier analysis was made. The independent effect of unsuspected N2 disease on mortality was analyzed using multivariate analysis.
Results
A total of 3271 patients with pathologic stage III-N2 NSCLC underwent curative intent surgical resection with or without adjuvant chemotherapy or chemotherapy and radiation. Unsuspected N2 disease was identified in 48% of patients. Patients with unsuspected N2 disease were more likely to have T1 tumors (37 vs. 32%,
p
< 0.001). Unsuspected N2 disease did not impact 5-year overall survival compared with known N2 when adjuvant therapy was utilized (40 vs. 37%,
p
= 0.167). Multivariate analysis identified older age, higher comorbidity score, and treatment with surgery alone as independent risk factors for mortality. The presence of unsuspected N2 disease was not significant in this model.
Conclusions
The findings of this study suggest that unsuspected N2 disease is associated with equivalent 5-year survival compared to cN2 disease when adjuvant therapy is employed. These results support the use of adjuvant chemotherapy and radiation therapy when confronted with unsuspected N2 disease after surgical resection for stage IIIA-NSCLC.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>28799084</pmid><doi>10.1007/s00268-017-4165-6</doi><tpages>11</tpages></addata></record> |
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| source | Springer Nature |
| subjects | Abdominal Surgery Cancer Cancer therapies Cardiac Surgery Chemotherapy General Surgery Lung cancer Lung diseases Medicine Medicine & Public Health Mortality Multivariate analysis Non-small cell lung carcinoma Original Scientific Report Patients Radiation Radiation therapy Risk analysis Risk factors Surgery Survival Thoracic Surgery Tumors Vascular Surgery |
| title | The Significance of Upfront Knowledge of N2 Disease in Non-small Cell Lung Cancer |
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