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. 2014 May;9(5):612-21.
doi: 10.1097/JTO.0000000000000152.

National patterns of care and outcomes after combined modality therapy for stage IIIA non-small-cell lung cancer

Aalok P Patel  1 , Traves D Crabtree, Jennifer M Bell, Tracey J Guthrie, Clifford G Robinson, Daniel Morgensztern, Graham A Colditz, Daniel Kreisel, A Sasha Krupnick, Jeffrey D Bradley, G Alexander Patterson, Bryan F Meyers, Varun Puri
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National patterns of care and outcomes after combined modality therapy for stage IIIA non-small-cell lung cancer

Aalok P Patel et al. J Thorac Oncol. 2014 May.

Abstract

Introduction: The role of surgery in addition to chemotherapy and radiation for stage IIIA non-small-cell lung cancer (NSCLC) remains controversial. Because there are limited data on the benefit from surgery in this setting, we evaluated the use of combined modality therapy nationally and explored the outcomes with and without the addition of surgery.

Methods: Patient variables and treatment-related outcomes were abstracted for patients with clinical stage IIIA NSCLC from the National Cancer Database. Patients receiving chemotherapy and radiation were compared with those undergoing chemotherapy, radiation, and surgery (CRS) in any sequence.

Results: Between 1998 and 2010, 61,339 patients underwent combined modality treatment for clinical stage IIIA NSCLC. Of these, 51,979 (84.7%) received chemotherapy and radiation while 9360 (15.3%) underwent CRS. Patients in the CRS group were younger, more likely female patients and Caucasians, and had smaller tumors and lower Charlson comorbidity scores. The 30-day surgical mortality was 200 of 8993 (2.2%). The median overall survival favored the CRS group in both unmatched (32.4 months versus 15.7 months, p < 0.001) and matched analysis based on patient characteristics (34.3 versus 18.4 months, p < 0.001).

Conclusions: There is significant heterogeneity in the treatment of stage IIIA NSCLC in the United States. Patients selected for surgery in addition to chemoradiation therapy seem to have better long-term survival.

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Figures

Figure 1
Figure 1
Consort Diagram showing schema of study subject selection and analysis.
Figure 2
Figure 2
A: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus chemotherapy, radiation, and surgery (CRS). This is an unmatched comparison. B: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus chemotherapy, radiation, and surgery (CRS): propensity score matched comparison. C: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus trimodality therapy (neoadjuvant chemoradiation followed by surgery): This is an unmatched comparison. D: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus trimodality therapy (neoadjuvant chemoradiation followed by surgery): propensity score matched comparison.
Figure 2
Figure 2
A: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus chemotherapy, radiation, and surgery (CRS). This is an unmatched comparison. B: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus chemotherapy, radiation, and surgery (CRS): propensity score matched comparison. C: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus trimodality therapy (neoadjuvant chemoradiation followed by surgery): This is an unmatched comparison. D: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus trimodality therapy (neoadjuvant chemoradiation followed by surgery): propensity score matched comparison.
Figure 2
Figure 2
A: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus chemotherapy, radiation, and surgery (CRS). This is an unmatched comparison. B: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus chemotherapy, radiation, and surgery (CRS): propensity score matched comparison. C: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus trimodality therapy (neoadjuvant chemoradiation followed by surgery): This is an unmatched comparison. D: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus trimodality therapy (neoadjuvant chemoradiation followed by surgery): propensity score matched comparison.
Figure 2
Figure 2
A: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus chemotherapy, radiation, and surgery (CRS). This is an unmatched comparison. B: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus chemotherapy, radiation, and surgery (CRS): propensity score matched comparison. C: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus trimodality therapy (neoadjuvant chemoradiation followed by surgery): This is an unmatched comparison. D: Kaplan-Meier survival of patients undergoing combination chemotherapy and radiation (CR) versus trimodality therapy (neoadjuvant chemoradiation followed by surgery): propensity score matched comparison.
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