Author of

• 12573

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  P3.09 - Poster Session 3 - Combined Modality (ID 214)

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

  • 12586

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    P3.09-013 - Outcomes and predictors for recurrence and survival after neoadjuvant concurrent chemoradiation followed by operation in patients with clinical stage III-N2 non-small-cell lung cancer (ID 2053)

    09:30 - 09:30  |  Author(s): B. Kim
    • Abstract

    Background
    This study assessed the impact of imaging, surgical, histopathologic and patient-related factors on the risks of local and distant recurrence and overall survival for patients with stage III-N2 non small cell lung carcinoma (NSCLC) undergoing definitive resection after neoadjuvant concurrent chemoradiation (neoCCRT).

    Methods
    We retrospectively examined 129 consecutive patients with stage III-N2 NSCLC received neoCCRT followed by curative surgery between 2008 and 2011. We reviewed clinical data and operation method. We also analyzed histopathologic factors such as subtype, pathologic invasive tumor characteristics, differentiation, residual tumor size, or the number of residual LNs as well as imaging characteristics on chest CT and PET/CT. Disease free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and predictive factors for recurrence and survival were identified by univariate and multivariate Cox-proportional analyses.

    Results
    112 (87%) patients were pathologically staged for N2-positive status (82 patients by mediastinoscopic biopsy and 30 patients by EBUS). The 5-year recurrence rate was 28.3 %, and the 5-year survival rate was 43.4 %. Five-year OS for patients with recurrence compared with those without was 29.5 versus 59.1 % (P = 0.028). Based on the multivariate Cox-proportional analysis and log-rank test, history of adjuvant therapy was the only significant prognostic predictor for prolonged OS (HR 0.134, 95 % CI 0.039–0.455, P = 0.001). As for recurrence, less size decrease on CT (HR 1.030, 95 % CI 1.005–1.056, P = 0.017), higher T stage (HR 2.450, 95 % CI 1.322–4.540, P = 0.004), larger residual tumor size on the pathologic specimen (HR 1.124, 95 % CI 1.010–1.252, P = 0.016), and presence of lymphovascular invasion (HR 4.180, 95 % CI 1.093–15.984, P = 0.037) were the significant predictors in both the multivariate Cox-proportional analysis and the log-rank test. Figure 1

    Conclusion
    Recurrence remains high in resected stage III-N2 NSCLC patients after neoCCRT and nodal downstaging, and patients who received adjuvant therapy had longer overall survival rate than patients who did not. Size decrease on CT, T stage, residual tumor size on the pathologic specimen, and presence of lymphovascular invasion would be predictive for higher recurrence and may necessitate more aggressive adjuvant treatment.