Author of

• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12506

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    P3.07-011 - Prognostic and predictive factors for recurrence-free survival in patients with completely resected pN2 non-small cell lung cancer (ID 1001)

    09:30 - 09:30  |  Author(s): H. Uehara
    • Abstract

    Background
    The role of surgical resection remains controversial for pathologic N2 (pN2) non-small cell lung cancer (NSCLC). The objective of our study was to determine the prognostic and predictive factors for recurrence-free survival (RFS) in patients with completely resected pN2 NSCLC.

    Methods
    Between 1990 and 2009, 2439 patients with NSCLC underwent curative surgical resection at the Cancer Institute Hospital. Of these patients, 311 (12.8%) were diagnosed as having pN2 NSCLC. Surgical resection was performed in 79, 71, 70, and 91 patients in 1990–1994, 1995–1999, 2000–2004, and 2005–2009, respectively. Overall survival (OS) and RFS were calculated using the Kaplan-Meier method, and survival outcomes were assessed using the log-rank test. Univariate and multivariate Cox proportional hazards models were used to identify factors influencing RFS.

    Results
    The patient population comprised 199 male and 112 female patients, with ages ranging from 16 to 84 years (median, 61.4). Lobectomies or bilobectomies were conducted in 263 cases, and pneumonectomies were performed in 48 cases. For the entire cohort, 5-year OS and 5-year RFS rates were 46% and 24%, respectively. The median follow-up time was 44 months. OS and RFS rates were 34% and 23% in 1990–1994, 42% and 34% in 1995–1999, 45% and 20% in 2000–2004, and 59% and 20% in 2005–2009, respectively. The recent improvement in OS was remarkable, whereas the RFS rate did not improve. Multivariate analysis identified 4 independent predictors for poor RFS: multiple-zone mediastinal lymph node metastasis (hazard ratio [HR], 1.551; P = .002), ipsilateral intrapulmonary metastasis (HR, 1.038; P = .002), tumor size > 30 mm (HR, 1.007; P = .046), and clinical N1 or N2 stage (HR, 1.039; P = .041). Patients were grouped according to the number of risk factors for poor RFS. Patients with none of the identified risk factors had an RFS rate of 32%, those with 1–2 factors had an RFS rate of 25%, and those with 3–4 factors had an RFS rate of 7% (P < .001).Figure 1

    Conclusion
    In patients with surgically resected pN2 NSCLC, OS tended to improve in recent years, whereas RFS was fairly constant over the study period. The overall prognosis of patients with surgically resected pN2 NSCLC remains poor. However, prognosis is considerably better in those patients with fewer risk factors. Accordingly, surgical resection could be beneficial in select patients.