Long-Term Results of Combined-Modality Therapy in Resectable Non–Small-Cell Lung Cancer
- 15 April 2002
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 20 (8), 1989-1995
- https://doi.org/10.1200/jco.2002.08.092
Abstract
PURPOSE: Assessment of long-term results of combined-modality therapy for resectable non–small-cell lung cancer is hampered by insufficient follow-up and small patient numbers. To evaluate this, we reviewed our collective experience. PATIENTS AND METHODS: This study was a retrospective chart review recording demographics, tumor stage, treatment, and outcome of consecutive patients undergoing surgery. Survival was analyzed by Kaplan-Meier, and prognostic factors were analyzed by log-rank and Cox regression. RESULTS: From January 1993 to December 1999, 470 patients were treated, with follow-up in 446: 27 stage I, 55 stage II, 316 stage III, 43 stage IV (solitary M1), and five uncertain. Chemotherapy was mitomycin/vinblastine/cisplatin (174 patients [39.0%]), carboplatin/paclitaxel (148 [33.2%]), and other combination (124 [27.8%]); 75 patients (16.8%) received induction radiation. Resection was complete in 77.4%, incomplete in 8.3%, attempted but with gross residual disease afterward in 1.8%, and not performed in 12.6%. Pathologic complete response occurred in 20 patients (4.5%). With median follow-up of 31.0 months for patients still alive, median and 3-year survival for pathologic stages 0, I, II, III, and IV were more than 90 months, 73%; 42 months, 52%; 23 months, 35%; 16 months, 28%; and 16 months, 23% (P < .001). In a multivariate analysis, age, complete resection, pathologic stage, and pneumonectomy, but not induction regimen, significantly influenced survival. CONCLUSION: Although pathologic complete response outside the protocol setting is low, survival of this large patient cohort is comparable to that of patients in published combined-modality trials. Survival is significantly influenced by patient age, complete resection, pathologic stage, and pneumonectomy. These results can help guide standard clinical practice and emphasize the need for novel induction regimens.Keywords
This publication has 30 references indexed in Scilit:
- Survival related to lymph node involvement in lung cancer after sleeve lobectomy compared with pneumonectomyThe Journal of Thoracic and Cardiovascular Surgery, 2000
- Does pneumonectomy for lung cancer adversely influence long-term survival?The Journal of Thoracic and Cardiovascular Surgery, 2000
- Induction chemotherapy before surgery for early-stage lung cancer: A novel approachThe Journal of Thoracic and Cardiovascular Surgery, 2000
- Induction chemotherapy for T4 centrally located non–small cell lung cancerThe Journal of Thoracic and Cardiovascular Surgery, 1999
- Safety and efficacy of bronchovascular reconstruction after induction chemotherapy for lung cancerThe Journal of Thoracic and Cardiovascular Surgery, 1997
- Adjuvant radiotherapy versus combined sequential chemotherapy followed by radiotherapy in the treatment of resected nonsmall cell lung carcinoma. A randomized trial of 267 patientsCancer, 1995
- Results of cancer and leukemia group B protocol 8935The Journal of Thoracic and Cardiovascular Surgery, 1995
- Adjuvant Chemotherapy With Cyclophosphamide, Doxorubicin, and Cisplatin in Patients With Completely Resected Stage I Non-Small-Cell Lung CancerJNCI Journal of the National Cancer Institute, 1993
- Preoperative chemotherapy and irradiation for stage III non-small cell lung cancerThe Annals of Thoracic Surgery, 1989
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958