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. 2013 Jun;20(6):1934-40.
doi: 10.1245/s10434-012-2800-x. Epub 2012 Dec 20.

Predictors for locoregional recurrence for clinical stage III-N2 non-small cell lung cancer with nodal downstaging after induction chemotherapy and surgery

Arya Amini  1 , Feiran Lou, Arlene M Correa, Randall Baldassarre, Andreas Rimner, James Huang, Jack A Roth, Stephen G Swisher, Ara A Vaporciyan, Steven H Lin
Affiliations

Predictors for locoregional recurrence for clinical stage III-N2 non-small cell lung cancer with nodal downstaging after induction chemotherapy and surgery

Arya Amini et al. Ann Surg Oncol. 2013 Jun.

Abstract

Purpose: Pathologic downstaging following chemotherapy for stage III-N2 NSCLC is a well-known positive prognostic indicator. However, the predictive factors for locoregional recurrence (LRR) in these patients are largely unknown.

Methods: Between 1998 and 2008, 153 patients with clinically or pathologically staged III-N2 NSCLC from two cancer centers in the United States were treated with induction chemotherapy and surgery. All had pathologic N0-1 disease, and none received postoperative radiotherapy. LRR were defined as recurrence at the surgical site, lymph nodes (levels 1-14 including supraclavicular), or both.

Results: Median follow-up was 39.3 months. Pretreatment N2 status was confirmed pathologically (18.2 %) or by PET/CT (81.8 %). Overall, the 5-year LRR rate was 30.8 % (n = 38), with LRR being the first site of failure in 51 % (22/+99877943). Five-year overall survival for patients with LRR compared with those without was 21 versus 60.1 % (p < 0.001). Using multivariate analysis, significant predictors for LRR were pN1 disease at time of surgery (p < 0.001, HR 3.43, 95 % CI 1.80-6.56) and a trend for squamous histology (p = 0.072, HR 1.93, 95 % CI 0.94-3.98). Five-year LRR rate for pN1 versus pN0 disease was 62 versus 20 %. Neither single versus multistation N2 disease (p = 0.291) nor initial staging technique (p = 0.306) were predictors for LRR. N1 status also was predictive for higher distant recurrence (p = 0.021, HR 1.91, 95 % CI 1.1-3.3) but only trended for poorer survival (p = 0.123, HR 1.48, 95 % CI 0.9-2.44).

Conclusions: LRR remains high in resected stage III-N2 NSCLC patients after induction chemotherapy and nodal downstaging, particularly in patients with persistent N1 disease.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier curves illustrating cumulative locoregional (LR) recurrence free probability in pathologically downstaged N0 versus N1 disease
Fig. 2
Fig. 2
Kaplan–Meier curves illustrating cumulative distant metastatic-free survival in patients with or without locoregional recurrence (a) and in pathologically downstaged N0 versus N1 disease (b). Kaplan–Meier curves illustrating cumulative overall survival with or without locoregional recurrence (c) and in downstaged N0 versus N1 disease (d)
See this image and copyright information in PMC

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