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Redefining the Risk of Surgery for Clinical Stage IIIA (N2) Non-Small Cell Lung Cancer: A Pooled Analysis of the STS GTSD and ESTS Registry

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Abstract

Background

Management of clinical stage IIIA-N2 (cIIIA-N2) non-small cell lung cancer (NSCLC) remains controversial. We evaluated treatment strategies and outcomes in cIIIA-N2 NSCLC patients who underwent pulmonary resection in The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) and the European Society of Thoracic Surgeons (ESTS) Registry.

Methods

The STS GTSD and ESTS Registry were queried for patients who underwent pulmonary resection for cIIIA-N2 NSCLC between 2012 and 2016. Demographic variables, treatment strategies, and outcome measures were collected and analyzed. Significance of differences was determined using the χ2 test for categorical variables and the Wilcoxon rank sum test for continuous variables.

Results

Pulmonary resection was performed in 4279 cIIIA-N2 NSCLC patients (2928 STS GTSD; 1351 ESTS). Induction therapy was administered to 49%. Lobectomy was performed in 67.1% and pneumonectomy in 13%. Lobectomy was associated with 19.2% major morbidity and 1.6% operative mortality, while pneumonectomy was associated with 34.1% and 5%, respectively. Induction therapy was associated with a higher rate of major morbidity or mortality than upfront surgery (23.2% vs 19.5%, p = 0.004), driven by pneumonectomy (40.7% vs 30.3%, p = 0.012) rather than lobectomy (20.3% vs 18.8%, p = 0.31).

Conclusions

Pulmonary resection for cIIIA-N2 NSCLC is associated with low rates of operative morbidity and mortality, with lobectomy having lower morbidity and mortality than pneumonectomy. Induction therapy, particularly chemoradiotherapy, is associated with a higher rate of composite morbidity or mortality than upfront surgery in pneumonectomy patients but not lobectomy patients.

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Acknowledgements

The data for this research were provided by the Society of Thoracic Surgeons’ National Database Participant User File Research Program. Data analysis were performed at the investigators’ institutions.

Funding

This study was funded by the Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.

Author information

Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, 60612, USA

    Michael J. Liptay, Justin M. Karush, Nicole Geissen, Sanjib Basu & Christopher W. Seder

  2. Department of Thoracic Surgery, St. James’s University Hospital, Leeds, UK

    Alessandro Brunelli

  3. Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK

    Silvia Cicconi

  4. Department of Thoracic Surgery, Nouvel Hopital Civil, Strasbourg, France

    Pierre-Emmanuel Falcoz

  5. Unit of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy

    Michele Salati

  6. Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Benjamin Kozower

  7. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Gaetano Rocco

  8. Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Professional Building, Suite 774, Chicago, IL, 60612, USA

    Andrew T. Arndt

Authors
  1. Andrew T. Arndt
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  2. Alessandro Brunelli
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  3. Silvia Cicconi
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  4. Pierre-Emmanuel Falcoz
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  5. Michele Salati
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  6. Benjamin Kozower
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  7. Michael J. Liptay
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  8. Gaetano Rocco
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  9. Justin M. Karush
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  10. Nicole Geissen
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  11. Sanjib Basu
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  12. Christopher W. Seder
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Corresponding author

Correspondence to Andrew T. Arndt.

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The authors have no conflicts of interest.

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This abstract was presented as an oral presentation at The Society of Thoracic Surgeons 2020 Annual Meeting, January 25–28, 2020 in New Orleans, LA, USA.

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Arndt, A.T., Brunelli, A., Cicconi, S. et al. Redefining the Risk of Surgery for Clinical Stage IIIA (N2) Non-Small Cell Lung Cancer: A Pooled Analysis of the STS GTSD and ESTS Registry. Lung 199, 311–318 (2021). https://doi.org/10.1007/s00408-021-00447-5

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  • DOI: https://doi.org/10.1007/s00408-021-00447-5

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