Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2015 Jun;99(6):1921-8.
doi: 10.1016/j.athoracsur.2015.02.033. Epub 2015 Apr 23.

Role for Surgical Resection in the Multidisciplinary Treatment of Stage IIIB Non-Small Cell Lung Cancer

Matthew J Bott  1 , Aalok P Patel  1 , Traves D Crabtree  1 , Daniel Morgensztern  2 , Clifford G Robinson  3 , Graham A Colditz  1 , Saiama Waqar  2 , Daniel Kreisel  1 , A Sasha Krupnicka  1 , G Alexander Patterson  1 , Stephen Broderick  1 , Bryan F Meyers  1 , Varun Puri  4
Affiliations
Multicenter Study

Role for Surgical Resection in the Multidisciplinary Treatment of Stage IIIB Non-Small Cell Lung Cancer

Matthew J Bott et al. Ann Thorac Surg. 2015 Jun.

Abstract

Background: The role of multimodality therapy in stage IIIB non-small cell lung cancer (NSCLC) remains inadequately studied. Although chemoradiation is currently the mainstay of treatment, randomized trials evaluating surgical intervention are lacking, and resection is offered selectively.

Methods: Data from patients with clinical stage IIIB NSCLC (T4N2 or any N3) undergoing definitive multimodality therapy were obtained from the National Cancer Database (NCDB). Multivariable Cox regression models were fitted to evaluate variables influencing overall survival (OS).

Results: From 1998 to 2010, 7,459 patients with clinical stage IIIB NSCLC were treated with definitive chemoradiation (CR group), whereas 1,714 patients underwent chemotherapy, radiation, and surgical intervention in any sequence (CRS group). CRS patients were more likely to be younger and white and have slightly smaller tumors (all p < 0.01). There was no difference in Charlson Comorbidity Index (CCI) between the groups (p = 0.5). In the CRS group, 79% of patients received neoadjuvant therapy. Thirty-day surgical mortality was 3%. Factors associated with improved OS in multivariate analysis included younger age, female sex, decreased CCI, smaller tumor size, and surgical resection (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.52-0.63). Among patients treated with surgical intervention, incomplete resection was associated with decreased OS (HR, 1.52; 95% CI, 1.20-1.92). Median OS was longer in the CRS group (25.9 months versus 16.3 months; p < 0.001). Propensity matched analysis on 631 patient pairs treated with CRS versus CR confirmed these findings (median OS, 28.9 versus 17.2 months; p < 0.001).

Conclusions: Surgical resection as a part of multimodality therapy may be associated with improved OS in highly selected patients with stage IIIB NSCLC. Multidisciplinary evaluation of these patients is critical.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Consort diagram for 170,135 patients with stage IIIB NSCLC identified in the National Cancer Database.
Figure 2
Figure 2. Kaplan-Meier curve for overall survival in patients receiving chemoradiation versus chemoradiation plus surgery (p<0.001)
Figure 3
Figure 3
Kaplan-Meier curve for overall survival in CR vs. CRS patients after propensity score matching of 631 patient pairs (p<0.001).
See this image and copyright information in PMC

References

    1. American Cancer Society. Cancer Facts and Figures 2014. Atlanta: American Cancer Society; 2014.
    1. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th. New York, NY: Springer; 2010.
    1. Ramnath N, Dilling TJ, Harris LJ, Kim AW, Michaud GC, Balekian AA, Diekemper R, Detterbeck FC, Arenberg DA. Treatment of Stage III Non-small Cell Lung Cancer - Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST. 2013;143(5 (Suppl)):e314S–e340S. - PubMed
    1. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, Postmus PE, Rusch V, Sobin L. The IASLC Lung Cancer Staging Project: Proposals for the Revision of the TNM Stage Groupings in the Forthcoming (Seventh) Edition of the TNM Classification of Malignant Tumours. J Thorac Oncol. 2007;2:706–714. - PubMed
    1. Albain KS, Rusch VW, Crowley JJ, Rice TW, Turrisi AT, Weick JK, Lonchyna VA, Presant CA, McKenna RJ, Gandara DR, Fosmire H, Taylor SA, Stelzer KJ, Beasley KR, Livingston RB. Concurrent Cisplatin/Etoposide Plus Chest Radiotherapy Followed by Surgery for Stages IIIA (N2) and IIIB Non-Small-Cell Lung Cancer: Mature Results of Southwest Oncology Group Phase II Study 8805. J Clin Oncol. 1995;13:1880–1892. - PubMed

Publication types

MeSH terms