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5. Outcomes For Resected Stage IIIA Non-Small Cell Lung Cancer Over 15 Years at a Single Institution.
Linda W Martin, Arlene M Correa, Marcelo Dolormente, Rhodette Francisco, Faye Martin, Arcenio J Sarabia, Waun Ki Hong, W. Roy Smythe, Joe B Putnam, Jr., Wayne Hofstetter, David C Rice, Ara A Vaporciyan, Stephen G Swisher, Garrett L Walsh, Jack A Roth; Houston, Temple, TX; Nashville, TN; , TX
Objective: The impact of multimodality treatment including surgery, chemotherapy, and radiation for potentially resectable stage IIIA non-small cell lung cancer (NSCLC) in a practice setting remains to be defined. We evaluated outcomes for these patients at our institution over a 15 year period to determine which treatment factors were associated with improved survival.
Methods: We surveyed our institutional pathology database from 1986 - 2001 for resected pathologic stage IIIA NSCLC patients. 378 patients were confirmed to have appropriate pathologic staging and attempted complete resection. These patients were assessed by univariate and multivariable analysis for factors associated with long-term survival. Stage migration was estimated using a classification based on nodal station involvement.
Results: Median potential follow up was 131 months. During the study period 3-year survival increased; pre-operative staging improved, relatively more lobectomies and fewer pneumonectomies were performed, and multimodality treatment was employed more frequently (Table 1). The number of positive nodal stations did not change over time (p=0.252). Surgery alone resulted in 3-year survival of 30.2%; perioperative chemotherapy and/or radiation increased 3-year survival to 37.6% (p=0.0035) (Figure). Multivariable analysis showed that male gender (HR 1.30,CI 1.01-1.68, p=0.04), age (HR 1.014, CI 1.002-1.03, p=0.02), more than two positive mediastinal nodal stations (HR 1.82, CI 1.35-2.45, p<0.0001), R1 resection (HR 1.84, CI 1.29-2.63, p=0.001), and surgery alone (HR 1.60, CI 1.25-2.06, p<0.0001) were negative independent predictors of survival.
Conclusions: Improved patient selection through better staging and the use of multimodality therapy appears to contribute to improved outcomes over time in resected stage IIIA NSCLC patients.
Table 1. Evolution of Treatment Over 15 Years
| Characteristic |
1986-1992
n=167 |
1993-2001
n=211 |
p-value |
| 3-year survival |
28.5% |
40.8% |
0.024 |
| 30-day Mortality |
4% (7) |
4% (9) |
0.972 |
| Mediastinoscopy |
17% (28) |
34%(71) |
<0.0001 |
| Type of surgery: |
- |
- |
<0.0001 |
| Wedge resection or Segmentectomy |
11% (19) |
6% (13) |
0.070 |
| Lobectomy |
53% (88) |
74% (157) |
<0.0001 |
| Pneumonectomy |
36% (60) |
19% (41) |
<0.0001 |
| Preoperative chemotherapy and/or radiation |
8% (13) |
21% (45) |
<0.0001 |
| Postoperative chemotherapyand/or radiation |
56% (94) |
69% (145) |
0.013 |
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