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Linda W. Martin
Wayne Hofstetter
David C. Rice
W. Roy Smythe
Stephen G. Swisher
Ara A. Vaporciyan
Garrett L. Walsh
Jack A. Roth
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Right arrow Lung - cancer

J Thorac Cardiovasc Surg 2005;130:1601-1610
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

The evolution of treatment outcomes for resected stage IIIA non–small cell lung cancer over 16 years at a single institution

Linda W. Martin, MD a , Arlene M. Correa, PhD a , Wayne Hofstetter, MD a , Waun Ki Hong, MD b , Ritsuko Komaki, MD c , Joe B. Putnam, Jr, MD d , David C. Rice, MD a , W. Roy Smythe, MD e , Stephen G. Swisher, MD a , Ara A. Vaporciyan, MD a , Garrett L. Walsh, MD a , Jack A. Roth, MD a , *

a Departments of Thoracic and Cardiovascular Surgery
b Medical Oncology
c Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex
d Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
e Department of Surgery, Texas A&M University Health Science Center, College Station, Tex

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication April 8, 2005; revisions received July 28, 2005; accepted for publication August 8, 2005.

* Address for reprints: Jack A. Roth, MD, FACS, The University of Texas MD Anderson Cancer Center, Professor and Chairman, Bud Johnson Clinical Distinguished Chair, Department of Thoracic & Cardiovascular Surgery, Professor of Molecular & Cellular Oncology, Director, W. M. Keck Center for Cancer Gene Therapy, Unit 445, Houston, TX 77230-1402 (Email: jroth{at}mdanderson.org).

OBJECTIVES: The effect of multimodality treatment including surgical intervention, chemotherapy, and radiation for potentially resectable stage IIIA non–small cell lung cancer in a practice setting remains to be defined. To determine which treatment factors are associated with improved survival, we evaluated outcomes for these patients at our institution over a 16-year period.

METHODS: We surveyed our institutional pathology database from 1986 through 2001 for patients with resected pathologic stage IIIA (N2) non–small cell lung cancer. Three hundred fifty-three patients were confirmed to have appropriate pathologic staging and attempted complete resection. These patients were assessed by means of univariate and multivariable analysis for factors associated with long-term survival. Stage migration was estimated by using a classification based on nodal station involvement.

RESULTS: Median potential follow-up was 132 months. During the study period, 3- and 5-year survival increased; preoperative staging improved, relatively more lobectomies and fewer pneumonectomies were performed, and multimodality treatment was used more frequently. The number of positive N2 nodal stations did not change over time (P = .14). Surgical intervention alone resulted in 3-year survival of 30%, and perioperative chemotherapy, radiation, or both increased 3-year survival to 38% (P = .004). Multivariable analysis showed that male sex (hazard ratio, 1.44; 95% confidence interval, 1.13-1.84; P = .003), more than 2 positive mediastinal nodal stations (hazard ratio, 1.73; 95% confidence interval, 1.16-2.57; P = .007), R1 or R2 resection (hazard ratio, 1.72; 95% confidence interval, 1.22-2.41; P = .002), lower or middle lobe tumor location (hazard ratio, 1.63; 95% confidence interval, 1.28-2.08; P < .001), and surgical intervention alone (hazard ratio, 1.59; 95% confidence interval, 1.23-2.04; P < .001) were independent predictors of poor survival.

CONCLUSIONS: The use of multimodality therapy appears to contribute to improved outcomes over time in patients with resected stage IIIA (N2) non–small cell lung cancer.

Abbreviations and Acronyms NSCLC = non–small cell lung cancer




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