DOI QR코드

DOI QR Code

Prognostic Factors for Lymph Node Negative Stage I and IIA Non-small Cell Lung Cancer: Multicenter Experiences

  • Ustaalioglu, Bala Basak Oven (Department of Medical Oncology, Haydarpasa Numune Education and Research Hospital) ;
  • Unal, Olcun Umit (Eylul University Medical Faculty) ;
  • Turan, Nedim (Gazi University Medical Faculty) ;
  • Bilici, Ahmet (Department of Medical Oncology, Medipol University) ;
  • Kaya, Serap (Kocaeli University Medical Faculty) ;
  • Eren, Tulay (Ankara Numune Education and Research Hospital) ;
  • Ulas, Arife (Ankara Oncology Hospital) ;
  • Inal, Ali (Dicle University Medical Faculty) ;
  • Berk, Veli (Erciyes University Medical Faculty) ;
  • Demirci, Umut (Ataturk Education and Research Hospital) ;
  • Alici, Suleyman (Department of Medical Oncology, Medical Park Hospital) ;
  • Bal, Oznur (Ankara Numune Education and Research Hospital) ;
  • Benekli, Mustafa (Gazi University Medical Faculty) ;
  • Gumus, Mahmut (Department of Medical Oncology, Kartal Education and Research Hospital)
  • Published : 2013.11.30

Abstract

Background: Surgery is the only curative treatment for operable non-small lung cancer (NSCLC) and the importance of adjuvant chemotherapy for stage IB patients is unclear. Herein, we evaluated prognostic factors for survival and factors related with adjuvant treatment decisions for stage I and IIA NSCLC patients without lymph node metastasis. Materials and Methods: We retrospectively analyzed 302 patients who had undergone curative surgery for prognostic factors regarding survival and clinicopathological factors related to adjuvant chemotherapy. Results: Nearly 90% of the patients underwent lobectomy or pneumonectomy with mediastinal lymph node resection. For the others, wedge resection were performed. The patients were diagnosed as stage IA in 35%, IB in 49% and IIA in 17%. Histopathological type (p=0.02), tumor diameter (p=0.01) and stage (p<0.001) were found to be related to adjuvant chemotherapy decisions, while operation type, lypmhovascular invasion (LVI), grade and the presence of recurrence were important factors in predicting overall survival (OS), and operation type, tumor size greater than 4 cm, T stage, LVI, and visceral pleural invasion were related with disease free survival (DFS). Multivariate analysis showed operation type (p<0.001, hazard ratio (HR):1.91) and the presence of recurrence (p<0.001, HR:0.007) were independent prognostic factors for OS, as well visceral pleural invasion (p=0.01, HR:0.57) and LVI (p=0.004, HR:0.57) for DFS. Conclusions: Although adjuvant chemotherapy is standard for early stage lymph node positive NSCLC, it has less clear importance in stage I and IIA patients without lymph node metastasis.

Keywords

Non-small cell lung cancer;lymph node negative;adjuvant chemotherapy;prognosis

References

  1. Arriagada R, Dunant A, Pignon JP, et al (2010). Long-term results of the international adjuvant lung cancer trial evaluating adjuvant Cisplatin-based chemotherapy in resected lung cancer. J Clin Oncol, 28, 35-42. https://doi.org/10.1200/JCO.2009.23.2272
  2. Bouchard N, Laberge F, Raby B, et al (2008). Adjuvant chemotherapy in resected lung cancer: two-year experience in a university hospital. Can Respir J, 15, 270-4. https://doi.org/10.1155/2008/462147
  3. Butts CA, Ding K, Seymour L, et al (2010). Randomized phase III trial of vinorelbine plus cisplatin compared with observation in completely resected stage IB and II non-small-cell lung cancer: updated survival analysis of JBR-10. J Clin Oncol, 28, 29-34. https://doi.org/10.1200/JCO.2009.24.0333
  4. Carbone DP, Felip E (2011). Adjuvant therapy in non-small cell lung cancer: future treatment prospects and paradigms. Clin Lung Cancer, 12, 261-71. https://doi.org/10.1016/j.cllc.2011.06.002
  5. Cho S, Park TI, Lee EB, et al (2012). Poor prognostic factors in surgically resected stage I non-small cell lung cancer: histopathologic and immunohistochemical analysis. Korean J Thorac Cardiovasc Surg, 45, 101-9. https://doi.org/10.5090/kjtcs.2012.45.2.101
  6. Custodio AB, Gonzalez-Larriba JL, et al (2009). Prognostic and predictive markers of benefit from adjuvant chemotherapy in early-stage non-small cell lung cancer. J Thorac Oncol, 4, 891-910. https://doi.org/10.1097/JTO.0b013e3181a4b8fb
  7. Custodio AB, Garcia Saenz JA, et al (2008). Adjuvant chemotherapy for early-stage non-small-cell lung cancer. Single-centre experience and literature review. Clin Transl Oncol, 10, 560-71. https://doi.org/10.1007/s12094-008-0251-x
  8. Edge SB, Byrd DR, Compton CC (2010). AJCC Cancer Staging Manual, Seventh Edition. New York:Springer, 1-730.
  9. Ioannidis G, Georgoulias V, Souglakos J (2011). How close are we to customizing chemotherapy in early non-small cell lung cancer? Ther Adv Med Oncol, 3, 185-205. https://doi.org/10.1177/1758834011409973
  10. Kato H, Ichinose Y, Ohta M, et al (2004). Japan lung cancer research group on postsurgical adjuvant chemotherapy. a randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med, 350, 1713-21. https://doi.org/10.1056/NEJMoa032792
  11. Kelsey CR, Marks LB, Hollis D, et al (2009). Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients. Cancer, 115, 5218-27. https://doi.org/10.1002/cncr.24625
  12. Pignon JP, Tribodet H, Scagliotti GV, et al (2008). LACE Collaborative Group. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol, 26, 3552-9. https://doi.org/10.1200/JCO.2007.13.9030
  13. Sangha R, Price J, Butts CA (2010). Adjuvant therapy in non-small cell lung cancer: current and future directions. Oncologist, 15, 862-72. https://doi.org/10.1634/theoncologist.2009-0186
  14. Strauss GM, Herndon JE 2nd, Maddaus MA, et al (2008). Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the cancer and leukemia group B, radiation therapy oncology group, and north central cancer treatment group study groups. J Clin Oncol, 26, 5043-51. https://doi.org/10.1200/JCO.2008.16.4855
  15. Suehisa H, Toyooka S (2009). Adjuvant chemotherapy for completely resected non-small-cell lung cancer. Acta Med Okayama, 63, 223-30.
  16. Sun Z, Aubry MC, Deschamps C, et al (2006). Histologic grade is an independent prognostic factor for survival in non-small cell lung cancer: an analysis of 5018 hospital- and 712 population-based cases. J Thorac Cardiovasc Surg, 131, 1014-20. https://doi.org/10.1016/j.jtcvs.2005.12.057
  17. Visbal AL, Leighl NB, Feld R, et al (2005). Adjuvant chemotherapy for early-stage non-small cell lung cancer. Chest, 128, 2933-43. https://doi.org/10.1378/chest.128.4.2933
  18. Wang WL, Shen-Tu Y, Wang ZQ (2011). Prognostic Factors for survival of stage IB upper lobe non-small cell lung cancer patients: a retrospective study in Shanghai, China. Chin J Cancer Res, 23, 265-70. https://doi.org/10.1007/s11670-011-0265-2
  19. Winget M, Fleming J, Li X, et al (2011). Uptake and tolerance of adjuvant chemotherapy in early stage NSCLC patients in Alberta, Canada. Lung Cancer, 72, 52-8. https://doi.org/10.1016/j.lungcan.2010.07.005
  20. Zhang Z, Wang A, Zhan Z, et al (2012). T1aN0M0 and T1bN0M0 non-small cell lung cancer: a retrospective study of the prognosis. Thorac Cardiovasc Surg, [Epub ahead of print].

Cited by

  1. Radiosensitization Effect of Overexpression of Adenovirus-mediated SIRT6 on A549 Non-small Cell Lung Cancer Cells vol.15, pp.17, 2014, https://doi.org/10.7314/APJCP.2014.15.17.7297
  2. Expression of ERCC1, RRM1 and LRP in Non-small Cell Lung Cancers and their Influence on Chemotherapeutic Efficacy of Gemcitabine Concomitant with Nedaplatin vol.15, pp.17, 2014, https://doi.org/10.7314/APJCP.2014.15.17.7303
  3. Experimental Study on Inhibition Effects of the XAF1 Gene against Lung Cancer Cell Proliferation vol.15, pp.18, 2014, https://doi.org/10.7314/APJCP.2014.15.18.7825
  4. Randomized Control Study of Nedaplatin or Cisplatin Concomitant with Other Chemotherapy in the Treatment of Advanced Non-small Cell Lung Cancer vol.15, pp.2, 2014, https://doi.org/10.7314/APJCP.2014.15.2.731
  5. Expression and Prognostic Roles of TRPV5 and TRPV6 in Non-Small Cell Lung Cancer after Curative Resection vol.15, pp.6, 2014, https://doi.org/10.7314/APJCP.2014.15.6.2559
  6. Is there any Potential Clinical Impact of Serum Phosphorus and Magnesium in Patients with Lung Cancer at First Diagnosis? A Multi-institutional Study vol.16, pp.1, 2015, https://doi.org/10.7314/APJCP.2015.16.1.77