Multimodal Treatment in Operable Stage III NSCLC: A Pooled Analysis on Long-Term Results of Three SAKK trials (SAKK 16/96, 16/00, and 16/01)

• Published in: Journal of thoracic oncology 2019-01, Vol.14 (1), p.115-123
• Main Authors: Früh, Martin, Betticher, Daniel C., Stupp, Roger, Xyrafas, Alexandros, Peters, Solange, Ris, Hans Beat, Mirimanoff, Rene Olivier, Ochsenbein, Adrian F., Schmid, Ralph, Matzinger, Oscar, Stahel, Rolf A., Weder, Walter, Guckenberger, Matthias, Rothschild, Sacha I., Lardinois, Didier, Mach, Nicholas, Mark, Michael, Gautschi, Oliver, Thierstein, Sandra, Biaggi Rudolf, Christine, Pless, Miklos
• Format: Article
• Language: English
• Subjects: Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Carcinoma, Non-Small-Cell Lung - therapy; Female; Humans; Long-term survival; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lung Neoplasms - therapy; Neoplasm Staging; NSCLC; Preoperative radiotherapy; Stage III
• ISSN: 1556-0864; 1556-1380
• DOI: 10.1016/j.jtho.2018.09.011

Long-term data on outcomes of operable stage III NSCLC are scarce. Individual patient data from 368 patients enrolled in one phase III and two phase II trials were pooled and outcomes after applying the eighth (denoted with an asterisk [*]) versus the sixth TNM staging edition were compared. Patients were treated with either preoperative radiotherapy following 3 cycles of induction chemotherapy (trimodal) or neoadjuvant chemotherapy alone (bimodal). With the sixth version, the 5- and 10-year survival rates were 38% and 28% for stage IIIA, respectively, and 36% and 24% for stage IIIB, respectively. Factors associated with improved 5-year overall survival were younger age, R0 resection, and pathologic complete remission (pCR) (p = 0.043, p < 0.001 and p = 0.009). With the eighth TNM staging version, 162 patients were moved from stage IIIA to IIIB*. The 5- and 10-year survival rates were 41% and 29% for stage IIIA*, respectively, and 35% and 27% for stage IIIB* patients, respectively. There was no difference in the bi- versus trimodal group with regard to median overall survival (28 months [95% confidence interval (CI): 21–39 months] and 37 months [95% CI: 24–51 months], p = 0.9) and event-free survival (12 months [95% CI: 9–15 months] versus 13 months [95% CI: 10–22 months], p = 0.71). We showed favorable 10-year survival rates of 29% and 27% in stage IIIA* and IIIB*, respectively. Younger age, R0 resection, and pathologic complete response were associated with improved long-term survival. Outcomes using the sixth versus eighth edition of the TNM classification were similar in operable stage III NSCLC.