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Predictive factors for survival in stage IIIA N2 NSCLC patients treated with neoadjuvant CCRT followed by surgery

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Abstract

Purpose

To assess the impact of imaging, surgical, histopathologic and patient-related factors on the risks of recurrence and overall survival (OS) in stage IIIA-N2 non-small cell lung cancer (NSCLC) patients undergoing definitive resection after neoadjuvant concurrent chemoradiotherapy (CCRT).

Methods

We retrospectively examined 104 consecutive patients with stage IIIA-N2 NSCLC who received neoadjuvant CCRT followed by surgery between 2008 and 2011. While reviewing the clinical and surgical data, we also assessed histopathologic and imaging (CT and PET/CT) factors. Disease-free survival (DFS) and OS were estimated with predictors for recurrence and survival.

Results

The 3-year OS for patients with and without recurrence was 37.1 and 63.3 %, respectively (p < 0.001). Size decrease of target lesion(s) ≥36 % on post-neoadjuvant CCRT CT (p = 0.048) and viable tumor size on surgical specimen <9.4 mm (p = 0.035) were related to longer OS. Regarding shorter DFS, tumor size on post-neoadjuvant CCRT CT (p = 0.046), SUVmax of the primary tumor (p = 0.011), male gender (p = 0.023), total tumor size on surgical specimen (p = 0.041) and viable tumor size on surgical specimen (p = 0.043) were the significant predictors.

Conclusions

OS is prolonged with greater extent of size decrease of target lesion(s) on post-neoadjuvant CCRT CT and smaller viable tumor size on surgical specimen. Larger tumor size on post-neoadjuvant CCRT CT, higher SUVmax, male gender, larger total tumor size and larger viable tumor size on surgical specimen may herald the higher probability of recurrence and the necessity of more attention.

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Authors and Affiliations

  1. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, Korea

    Hyun-ju Lim, Ho Yun Lee & Kyung Soo Lee

  2. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Jungho Han

  3. Division of Respiratory and Critical Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    O. Jung Kwon

  4. Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Keunchil Park

  5. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Yong Chan Ahn

  6. Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Byung-Tae Kim

  7. Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Young Mog Shim

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  1. Hyun-ju Lim
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280_2014_2619_MOESM1_ESM.tif

Figure S1. Kaplan–Meier survival curve of OS estimates according to the presence of recurrence in locally advanced NSCLC after neoadjuvant CCRT followed by surgery. There were statistically significant differences in OS when compared between the two groups with and without recurrence (p < 0.001) (online only). (TIFF 2192 kb)

280_2014_2619_MOESM2_ESM.tif

Figure S2. Kaplan–Meier survival curve of OS estimates according to the size of viable tumor on histologic specimen in locally advanced NSCLC after neoadjuvant CCRT followed by surgery. There were statistically significant differences in OS when compared between the two groups (p = 0.047) (online only). (TIFF 7773 kb)

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Lim, Hj., Lee, H.Y., Lee, K.S. et al. Predictive factors for survival in stage IIIA N2 NSCLC patients treated with neoadjuvant CCRT followed by surgery. Cancer Chemother Pharmacol 75, 77–85 (2015). https://doi.org/10.1007/s00280-014-2619-1

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  • DOI: https://doi.org/10.1007/s00280-014-2619-1

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