Surgical Resection for Residual N2 Disease After Induction Chemotherapy

Port, Jeffrey L.; Korst, Robert J.; Lee, Paul C.; Levin, Matthew A.; Becker, David; Keresztes, Roger; Altorki, Nasser K.

doi:10.1016/j.athoracsur.2004.10.057

Cited by 40 publications

(31 citation statements)

References 16 publications

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“…[14][15][16] The present multivariate analysis also showed that node metastasis was an independent prognostic factor, as seen in results reported previously. Additional adjuvant therapy could be considered in good-status patients with residual node metastasis.…”

Section: Discussionsupporting

confidence: 84%

Cardiopulmonary co-morbidity: a critical negative prognostic predictor for pulmonary resection following preoperative chemotherapy and/or radiation therapy in lung cancer patients

Inoue

Okumura

Minami

et al. 2007

Gen Thorac Cardiovasc Surg

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Objective. Preoperative therapy is an optional strategy for locally advanced lung cancer, although the indication for pulmonary resection is often marginal, when considering the survival benefi t and perioperative risks. The aim of the present study was to identify prognostic predictors by assessing clinical factors including prethoracotomy co-morbidity.Methods. This was a retrospective analysis of 54 patients who underwent complete resection after preoperative therapy was performed. Results. The overall 5-year survival rate was 38%. In patients without cardiopulmonary co-morbidity the 5-year survival rate was 49%, whereas it was 0% for those who had associated cardiopulmonary co-morbidity (P = 0.004). When analyzing only those who died from lung cancer, the group without cardiopulmonary comorbidity showed a tendency for longer survival than those in the co-morbidity group (P = 0.092). The 5-year survival rate for patients-evaluated with a Charlson Co-morbidity Index (CCI)-with a CCI score of 0, was 45%, which tended to be better than that for those with a CCI score of 1-2 (P = 0.066). Furthermore, patients with a normal prethoracotomy level of carcinoembryonic antigen (CEA) had a 5-year survival rate of 44%, which was better than the 22% for patients with elevated CEA (P = 0.013). The 5-year survival rate for patients without lymph node metastasis was 52%, whereas it was 14% for those with residual node involvement (P = 0.002). Lymph node metastasis and cardiopulmonary co-morbidity were shown to be independent poor prognostic predictors by multivariate analysis.Conclusion. In addition to nodal status, preoperative cardiopulmonary co-morbidity should be noted when considering the operative indications following preoperative therapy for lung cancer patients.

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Section: Discussionsupporting

confidence: 84%

Cardiopulmonary co-morbidity: a critical negative prognostic predictor for pulmonary resection following preoperative chemotherapy and/or radiation therapy in lung cancer patients

Inoue

Okumura

Minami

et al. 2007

Gen Thorac Cardiovasc Surg

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“…The hallmark of the study is that less than 60% reduction in N2 SUVmax significantly predicts the presence of residual N2 disease. Previous studies published by our group and others have shown that persistent N2 disease after induction therapy for patients with stage IIIA N2 disease is a significant negative prognostic factor, and those patients have significantly worse overall survival [3][4][5][6]. Although there is evidence that lobectomy results in improved survival when added to induction treatment for patients with N2 disease, there are limited data regarding the optimal treatment modalities for those patients with persistent mediastinal nodal disease [10].…”

Section: Commentmentioning

confidence: 94%

“…A number of previous studies have shown improved survival with the addition of preoperative therapies to surgical resection [2]. Our group and others have shown that persistent N2 disease after induction therapy was associated with a significantly worse overall survival compared with patients who had downstaged mediastinal disease [3][4][5][6]. A survey of surgeons on the Cardiothoracic Surgery Network showed that the vast majority of surgeons will not offer surgical resection for patients with persistent N2 disease after induction therapy for stage IIIA, and that only 19% of surgeons surveyed would do surgical resection regardless of the nodal downstaging status [7].…”

mentioning

confidence: 97%

Clinical Predictors of Persistent Mediastinal Nodal Disease After Induction Therapy for Stage IIIA N2 Non-Small Cell Lung Cancer

Kamel

Rahouma

Ghaly

et al. 2017

The Annals of Thoracic Surgery

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“…However, in our study, we demonstrated that patients with unexpected persistent N2 disease exhibited satisfactory survival rates. Port reported that certain patients may be cured by surgery, particularly in case of previous response to chemotherapy (23).…”

Section: Patient No (%) --------------------------------------------mentioning

confidence: 99%

Surgery following neoadjuvant chemotherapy for non-small-cell lung cancer patients with unexpected persistent pathological N2 disease

Duan

Jiang

et al. 2015

Molecular and Clinical Oncology

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Abstract.Patients with mediastinal lymph node (LN) downstaging following neoadjuvant chemotherapy exhibit improved outcomes compared with patients with persistent N2 disease. The aim of this study was to compare clinicopathological characteristics and survival between patients with unexpected and expected persistent N2 disease following surgery for non-small-cell lung cancer (NSCLC). This retrospective analysis included 348 patients with NSCLC who underwent surgery following chemotherapy at the Shanghai Pulmonary Hospital, Tongji University School of Medicine, between 1995 and 2012. According to the results of the imaging examinations and postoperative pathology, the patients were divided into three groups, namely groups I (nodal downstaging, pN0-1), II (expected persistent N2 disease) and III (unexpected persistent N2 disease). The rates of overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify the independent risk factors for OS and DFS. The mortality rate was 1.1% during the postoperative period. Perioperative complications occurred in 45 patients (12.9%). The 5-year OS rate was 32.2, 6.3 and 25.9% in groups I, II and III, respectively (group I vs. III, P=0.023; and group III vs. II, P<0.001). The 5-year DFS rate was 30.1, 5.1 and 22.4% in groups I, II and III, respectively (group I vs. III, P=0.012; and group III vs. II, P<0.001). Grouping, predicted forced expiratory volume in 1 sec, N downstaging and skip N2 metastasis were identified as independent predictive factors associated with OS, whereas the independent risk factors associated with DFS were grouping and N downstaging. Patients with unexpected persistent N2 disease exhibited better survival compared with those with expected persistent N2 disease. Surgery following chemotherapy remains the optimal approach for a proportion of patients with persistent N2 disease.

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Surgical Resection for Residual N2 Disease After Induction Chemotherapy

Cited by 40 publications

References 16 publications

Cardiopulmonary co-morbidity: a critical negative prognostic predictor for pulmonary resection following preoperative chemotherapy and/or radiation therapy in lung cancer patients

Cardiopulmonary co-morbidity: a critical negative prognostic predictor for pulmonary resection following preoperative chemotherapy and/or radiation therapy in lung cancer patients

Clinical Predictors of Persistent Mediastinal Nodal Disease After Induction Therapy for Stage IIIA N2 Non-Small Cell Lung Cancer

Surgery following neoadjuvant chemotherapy for non-small-cell lung cancer patients with unexpected persistent pathological N2 disease

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