Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non‐small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience

• Published in: Thoracic cancer 2017-09, Vol.8 (5), p.393-401
• Main Authors: Savic, Milan, Kontic, Milica, Ercegovac, Maja, Stojsic, Jelena, Bascarevic, Slavisa, Moskovljevic, Dejan, Kostic, Marko, Vesovic, Radomir, Popevic, Spasoje, Laban, Marija, Markovic, Jelena, Jovanovic, Dragana
• Format: Article
• Language: English
• Subjects: Adjuvant treatment; Adult; Age; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bias; Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Care and treatment; Chemotherapy; Chemotherapy, Adjuvant; Cisplatin - therapeutic use; Etoposide; Etoposide - therapeutic use; Female; Health aspects; Humans; Localization; Lung cancer; Lung cancer, Non-small cell; Lung cancer, Small cell; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Nodes; Male; Mediastinum; Metastasis; Middle Aged; neoadjuvant chemotherapy; Neoadjuvant Therapy; Neoplasm Staging; non‐small cell lung carcinoma; Original; Ostomy; Patients; prognosis; Radiation therapy; Retrospective Studies; stage IIIA; Standard deviation; Statistical analysis; Studies; Surgery; Survival Analysis; Thoracic surgery; Treatment Outcome; Tumors
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.12447

Background In spite of the progress made in neoadjuvant therapy for operable non small‐cell lung cancer (NSCLC), many issues remain unsolved, especially in locally advanced stage IIIA. Methods Retrospective data of 163 patients diagnosed with stage IIIA NSCLC after surgery was analyzed. The patients were divided into two groups: a preoperative chemotherapy group including 59 patients who received platinum‐etoposide doublet treatment before surgery, and an upfront surgery group including 104 patients for whom surgical resection was the first treatment step. Adjuvant chemotherapy or/and radiotherapy was administered to 139 patients (85.3%), while 24 patients (14.7%) were followed‐up only. Results The rate of N2 disease was significantly higher in the upfront surgery group ( P  < 0.001). The one‐year relapse rate was 49.5% in the preoperative chemotherapy group compared to 65.4% in the upfront surgery group. There was a significant difference in relapse rate in relation to adjuvant chemotheraphy treatment ( P  = 0.007). The probability of relapse was equal whether radiotherapy was applied or not ( P  = 0.142). There was no statistically significant difference in two‐year mortality ( P  = 0.577). The median survival duration after two years of follow‐up was 19.6 months in the preoperative chemotherapy group versus 18.8 months in the upfront surgery group ( P  = 0.608 > 0.05). Conclusion There was significant difference in preoperative chemotherapy group regarding relapse rate and treatment outcomes related to the lymph node status comparing to the upfront surgery group. Neoadjuvant/adjuvant chemo‐therapy is a part of treatment for patients with stage IIIA NSCLC, but further investigation is required to determine optimal treatment.