Objective: The role of surgery in patients with N2 non–small cell lung cancer is debated. The aim of this studywas to evaluate the results of surgical resection after induction chemotherapy.Methods: We retrospectively reviewed the cases of patients with N2 non–small cell lung cancer who underwentneoadjuvant chemotherapy followed by resection between 2001 and 2007. They all had tumors deemed resectable.Results: One hundred seventy-five patients entered the study. Most of them received 2 or 3 cycles of chemotherapy(81%), in all cases platinum-based regimens. Chemotherapy response rate was 62%. Operations included 96lobectomies/bilobectomies and 79 pneumonectomies. Complete resection rate was 94%, and perioperative mortalitywas 4.5%. A pathologic mediastinal downstaging was found in 39% of patients. Overall median survivaltime and 5-year survival were 34.7 months and 30%, respectively. Survival was affected by clinical response(median survival time 51 months and 5-year survival 42% for responders versus 19 months and 10% for nonresponders)and by nodal downstaging (51 months and 45%versus 25%and 22%). In the group of responders,nondownstaged patients showed satisfying survival (median survival time 30 months, 5-year survival 30%). Inthe group of nonresponders, survival was unsatisfactory when a lobectomy was performed (median survival time20 months, 5-year survival 13%) and poor in case of pneumonectomy (15 months and 6%). Multivariate analysisfound 4 factors significantly affecting survival: clinical response, nodal downstaging, number of chemotherapycycles, and histopathologic response.Conclusions: Surgery after chemotherapy could be effective for selected patients with N2 non–small cell lungcancer. Survival for responders is satisfactory, even in case of persistent N2 disease. Prognosis for nonrespondersis disappointing.

Which patients should be operated on after induction chemotherapy for N2 non–small cell lung cancer? Analysis of a 7-year experience in 175 patients / Stefani, Alessandro; M., Alifano; A., Bobbio; M., Grigoroiu; R., Jouni; P., Magdeleinat; Regnard, J. F.. - In: THE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 1097-685X. - STAMPA. - 140:2(2010), pp. 356-363. [10.1016/j.jtcvs.2010.02.018]

Which patients should be operated on after induction chemotherapy for N2 non–small cell lung cancer? Analysis of a 7-year experience in 175 patients

STEFANI, Alessandro;
2010

Abstract

Objective: The role of surgery in patients with N2 non–small cell lung cancer is debated. The aim of this studywas to evaluate the results of surgical resection after induction chemotherapy.Methods: We retrospectively reviewed the cases of patients with N2 non–small cell lung cancer who underwentneoadjuvant chemotherapy followed by resection between 2001 and 2007. They all had tumors deemed resectable.Results: One hundred seventy-five patients entered the study. Most of them received 2 or 3 cycles of chemotherapy(81%), in all cases platinum-based regimens. Chemotherapy response rate was 62%. Operations included 96lobectomies/bilobectomies and 79 pneumonectomies. Complete resection rate was 94%, and perioperative mortalitywas 4.5%. A pathologic mediastinal downstaging was found in 39% of patients. Overall median survivaltime and 5-year survival were 34.7 months and 30%, respectively. Survival was affected by clinical response(median survival time 51 months and 5-year survival 42% for responders versus 19 months and 10% for nonresponders)and by nodal downstaging (51 months and 45%versus 25%and 22%). In the group of responders,nondownstaged patients showed satisfying survival (median survival time 30 months, 5-year survival 30%). Inthe group of nonresponders, survival was unsatisfactory when a lobectomy was performed (median survival time20 months, 5-year survival 13%) and poor in case of pneumonectomy (15 months and 6%). Multivariate analysisfound 4 factors significantly affecting survival: clinical response, nodal downstaging, number of chemotherapycycles, and histopathologic response.Conclusions: Surgery after chemotherapy could be effective for selected patients with N2 non–small cell lungcancer. Survival for responders is satisfactory, even in case of persistent N2 disease. Prognosis for nonrespondersis disappointing.
2010
140
2
356
363
Which patients should be operated on after induction chemotherapy for N2 non–small cell lung cancer? Analysis of a 7-year experience in 175 patients / Stefani, Alessandro; M., Alifano; A., Bobbio; M., Grigoroiu; R., Jouni; P., Magdeleinat; Regnard, J. F.. - In: THE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 1097-685X. - STAMPA. - 140:2(2010), pp. 356-363. [10.1016/j.jtcvs.2010.02.018]
Stefani, Alessandro; M., Alifano; A., Bobbio; M., Grigoroiu; R., Jouni; P., Magdeleinat; Regnard, J. F.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/708336
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