Nodal stage of surgically resected non-small cell lung cancer and its effect on recurrence patterns and overall survival
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Authors
Varlotto, JohnYao, Aaron N.
DeCamp, Malcolm M.
Ramakrishna, Satvik
Recht, Abe
Flickinger, John
Andrei, Adin
Reed, Michael F.
Toth, Jennifer W.
FitzGerald, Thomas J
Higgins, Kristin
Zheng, Xiao
Shelkey, Julie
Medford-Davis, Laura N.
Belani, Chandra
Kelsey, Christopher R.
UMass Chan Affiliations
Department of Radiation OncologyDocument Type
Journal ArticlePublication Date
2015-03-15Keywords
AgedCarcinoma, Non-Small-Cell Lung
Female
Follow-Up Studies
Humans
Lung Neoplasms
Lymph Nodes
Lymphatic Metastasis
Male
Middle Aged
*Neoplasm Recurrence, Local
Retrospective Studies
Clinical Epidemiology
Neoplasms
Oncology
Radiology
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PURPOSE: Current National Comprehensive Cancer Network guidelines recommend postoperative radiation therapy (PORT) for patients with resected non-small cell lung cancer (NSCLC) with N2 involvement. We investigated the relationship between nodal stage and local-regional recurrence (LR), distant recurrence (DR) and overall survival (OS) for patients having an R0 resection. METHODS AND MATERIALS: A multi-institutional database of consecutive patients undergoing R0 resection for stage I-IIIA NSCLC from 1995 to 2008 was used. Patients receiving any radiation therapy before relapse were excluded. A total of 1241, 202, and 125 patients were identified with N0, N1, and N2 involvement, respectively; 161 patients received chemotherapy. Cumulative incidence rates were calculated for LR and DR as first sites of failure, and Kaplan-Meier estimates were made for OS. Competing risk analysis and proportional hazards models were used to examine LR, DR, and OS. Independent variables included age, sex, surgical procedure, extent of lymph node sampling, histology, lymphatic or vascular invasion, tumor size, tumor grade, chemotherapy, nodal stage, and visceral pleural invasion. RESULTS: The median follow-up time was 28.7 months. Patients with N1 or N2 nodal stage had rates of LR similar to those of patients with N0 disease, but were at significantly increased risk for both DR (N1, hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.30-2.59; P=.001; N2, HR = 2.32, 95% CI: 1.55-3.48; P < .001) and death (N1, HR = 1.46, 95% CI: 1.18-1.81; P < .001; N2, HR = 2.33, 95% CI: 1.78-3.04; P < .001). LR was associated with squamous histology, visceral pleural involvement, tumor size, age, wedge resection, and segmentectomy. The most frequent site of LR was the mediastinum. CONCLUSIONS: Our investigation demonstrated that nodal stage is directly associated with DR and OS but not with LR. Thus, even some patients with, N0-N1 disease are at relatively high risk of local recurrence. Prospective identification of risk factors for local recurrence may aid in selecting an appropriate population for further study of postoperative radiation therapy.Source
Int J Radiat Oncol Biol Phys. 2015 Mar 15;91(4):765-73. doi: 10.1016/j.ijrobp.2014.12.028. Link to article on publisher's siteDOI
10.1016/j.ijrobp.2014.12.028Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47973PubMed ID
25752390Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.ijrobp.2014.12.028