3 years ago

Upfront surgery as first line therapy in selected patients with stage IIIA non-small cell lung cancer

Surgery plays an important role in the multidisciplinary treatment strategy for patients with stage IIIA non-small cell lung cancer (NSCLC). Besides induction therapy, patients could benefit from surgery followed by adjuvant chemotherapy and radiotherapy. This study analyzed a subset of patients with pIIIA NSCLC who underwent upfront surgery as first line therapy. Methods Selected patients with pIIIA NSCLC who received upfront surgery were retrospectively analyzed. Clinicopathologic characteristics and survival outcomes including progression free survival (PFS) and overall survival (OS) were evaluated. Results A total of 668 patients were identified. Five hundred and sixty-five patients received adjuvant chemotherapy and 157 patients received adjuvant radiotherapy after surgery. The median PFS and OS were 17.0 and 44.0 months, respectively. The three-year and five-year PFS rate was 31.6% and 21.0%, the three-year and five-year OS rate was 54.7% and 43.0%. Patients with adenocarcinoma (AD) had better OS than those with squamous cell carcinoma (SCC) (5-year OS: p=0.026). Patients with low-grade AD (acinar and papillar) had a similar PFS and OS when compared with patients with high-grade AD (solid, micropapillar and mucinous) (5-year PFS: p=0.894; 5-year OS: p=0.439). Patients with mutated EGFR had a similar OS to patients with wild-type EGFR (5-year OS: p=0.121). Patients with clinical N0 status (p=0.004), and patients with single-station of pathologic N2 (p<0.001) had better OS. Conclusions Upfront surgery followed by adjuvant therapy may provide favorable survival outcomes for selected patients with pIIIA NSCLC, especially for patients with adenocarcinoma or patients with clinical N0 and pathological single-station N2 diseases.

Publisher URL: www.sciencedirect.com/science

DOI: S0022522317324091

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