Furrer, Katarzyna; Weder, Walter; Eboulet, Eric Innocents; Betticher, Daniel; Pless, Miklos; Stupp, Roger; Krueger, Thorsten; Perentes, Jean Yannis; Schmid, Ralph A; Lardinois, Didier; Furrer, Markus; Früh, Martin; Peters, Solange; Curioni-Fontecedro, Alessandra; Stahel, Rolf A; Rothschild, Sacha I; Hayoz, Stefanie; Opitz, Isabelle (2022). Extended resection for potentially operable patients with stage III non-small cell lung cancer after induction treatment. The journal of thoracic and cardiovascular surgery, 164(6), 1587-1602.e5. Elsevier 10.1016/j.jtcvs.2022.03.034
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OBJECTIVE
Surgical treatment of locally advanced non-small cell lung cancer including single or multilevel N2 remains a matter of debate. Several trials demonstrate that selected patients benefit from surgery if R0 resection is achieved. We aimed to assess resectability and outcome of patients with locally advanced clinical T3/T4 (American Joint Committee on Cancer 8th edition) tumors after induction treatment followed by surgery in a pooled analysis of 3 prospective multicenter trials.
METHODS
A total of 197 patients with T3/T4 non-small cell lung cancer of 368 patients with stage III non-small cell lung cancer enrolled in the Swiss Group for Clinical Cancer Research 16/96, 16/00, 16/01 trials were treated with induction chemotherapy or chemoradiation therapy followed by surgery, including extended resections. Univariable and multivariable analyses were applied for analysis of outcome parameters.
RESULTS
Patients' median age was 60 years, and 67% were male. A total of 38 of 197 patients were not resected for technical (81%) or medical (19%) reasons. A total of 159 resections including 36 extended resections were performed with an 80% R0 and 13.2% pathological complete response rate. The 30- and 90-day mortality were 3% and 7%, respectively, without a difference for extended resections. Morbidity was 32% with the majority (70%) of minor grading complications. The 3-, 5-, and 10-year overall survivals for extended resections were 61% (95% confidence interval, 43-75), 44% (95% confidence interval, 27-59), and 29.5% (95% confidence interval, 13-48), respectively. R0 resection was associated with improved overall survival (hazard ratio, 0.41; P < .001), but pretreatment N2 extension (177/197) showed no impact on overall survival.
CONCLUSIONS
Surgery after induction treatment for advanced T3/T4 stage including single and multiple pretreatment N2 disease resulted in 80% R0 resection rate and 7% 90-day mortality. Favorable overall survival for extended and not extended resection was demonstrated to be independent of pretreatment N status.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Thoracic Surgery |
UniBE Contributor: |
Schmid, Ralph, Früh, Martin |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1097-685X |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
13 Jun 2022 09:38 |
Last Modified: |
05 Dec 2022 16:20 |
Publisher DOI: |
10.1016/j.jtcvs.2022.03.034 |
PubMed ID: |
35688713 |
Uncontrolled Keywords: |
N2 extended resection locally advanced lung cancer multimodality treatment resectable NSCLC stage III NSCLC surgery |
BORIS DOI: |
10.48350/170604 |
URI: |
https://boris.unibe.ch/id/eprint/170604 |
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