Survival analysis of patients with non-small cell lung cancer who underwent surgical resection following 4 lung cancer resection guidelines

Abstract

BackgroundTo compare survival of patients with non-small cell lung cancer (NSCLC) who underwent surgical resection and lymph node sampling based on guidelines proposed by the American College of Surgeons Oncology Group (ACOSOG), National Comprehensive Cancer Network (NCCN), the OSI Pharmaceutical RADIANT trial, and the International Association for the Study of Lung Cancer (IASLC).MethodsMedical records of patients with NSCLC who underwent surgical resection from 2001 to 2008 at our hospital were reviewed. Staging was according to the 7th edition of the AJCC TNM classification of lung cancer. Patients who received surgical resection following the IASLC, ACOSOG, RADIANT or NCCN resection criteria were identified.ResultsA total of 2,711 patients (1803 males, 908 females; mean age, 59.6 ± 9.6 years) were included. Multivariate Cox proportional hazards regression analysis indicated that increasing age, adenosquamous histology, and TNM stage II or III were associated with decreased overall survival (OS). Univariate analysis and log-rank test showed that surgical resection following the guidelines proposed by the IASLC, NCCN, ACOSOG, or RADIANT trial was associated with higher cumulative OS rates (relative to resection not following the guidelines). Multivariate analysis revealed that there was a significant improvement in OS only when IASLC resection guidelines (complete resection) were followed (hazard ratio = 0.84, 95% confidence interval 0.716 to 0.985, P = 0.032).ConclusionsSurgical resection following the criteria proposed by IASLC, NCCN, ACOSOG, or the RADIANT trial was associated with a higher cumulative OS rate. However, significant improvement in OS only occurred when IASLC resection guidelines were followed.

Recurrence and Risk Factors for Relapse in Patients with Non-Small Cell Lung Cancer Treated by Surgery with Curative Intent

“…As in the international literature, adenocarcinoma was the predominant histological type (61.8%) [12,16,17] , and males were in the majority (68.6%) [6,12] . Strong lines of evidence have shown that current smokers have a significantly higher risk of lung cancer than nonsmokers.…”

“…Surgery is a potentially curative treatment for earlystage NSCLC patients (stage I and II) [5,6] but, unfortunately, only 15-30% of the patients are eventually suitable for surgical resection with a curative intent [2,4] . Tumor recurrence is the most common cause of treatment failure after surgical resection [4,5,8,12] .…”

“…Surgery remains a potentially curative treatment for early-stage NSCLC patients [5,6] . Surgical resection is considered the standard treatment for early-stage disease (stage I and II) [2,[7][8][9][10] and is also an accepted treatment modality in some locally advanced disease (stage IIIA) [2] .…”

Improved lymph node staging in early-stage lung cancer in the national cancer database: commentary

“…Remarkably, variables, including increasing year, age >65 years, male sex, non-African American race, academic centers, lobectomy, and clinical T2 disease, have been shown to correlate with >15 nodes that were assessed. Furthermore, Yue et al reported that increased adherence to these guidelines was associated with improved survival (15).…”

Primary adenocarcinoma of the lung – histological subtypes and outcome after surgery, using the IASLC/ATS/ERS classification of lung adenocarcinoma

“…Non‐small cell lung carcinoma (NSCLC) accounts for 85% of all lung cancer where adenocarcinoma (AC) is the most common histology . The strongest prognostic factors of survival for patients with NSCLC are the TNM stage , advanced age, history of weight loss , ethnicity , and some genetic mutations (i.e., EGFR, K‐RAS, p53) .The three major NSCLC histological types; squamous cell carcinoma (SCC), AC, and large cell carcinoma (LCC) have also been shown to influence survival in some studies , but not in all . Bronchioloalveolar adenocarcinoma (BAC) that was described as a subtype of AC, has been thought to have a better prognosis than non‐BAC adenocarcinomas .…”