Advertisement

Should patients with stage IB non-small cell lung cancer receive adjuvant chemotherapy? A comparison of survival between the 8th and 7th editions of the AJCC TNM staging system for stage IB patients

  • Jia Wang
  • Nan Wu
  • Chao Lv
  • Shi Yan
  • Yue YangEmail author
Original Article – Clinical Oncology
  • 40 Downloads

Abstract

Introduction

The aims of this study were to compare the efficacy of platinum-based adjuvant chemotherapy in resected patients with stage IB NSCLC according to the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging manuals on tumor, node, and metastasis (TNM) staging systems, respectively.

Methods

This retrospective analysis included 569 patients who underwent pulmonary resection for primary non-small cell lung cancer. 5-year overall survival (OS) was compared in stage IB disease using the 8th and 7th editions of the TNM classification, respectively. Survival curves were plotted using the Kaplan–Meier method, and log-rank test was used to evaluate differences between subgroups.

Results

The 5-year overall survival was 76.9% and 83.5% (p = 0.044) for patients in the observation and adjuvant groups, respectively. The presence of adjuvant chemotherapy, lymphovascular invasion, TNM stage, and performance status (PS) were risk factors for OS in univariate analysis. In multivariate analysis, TNM stage [hazard ratio (HR) 5.403, 95% confidence interval (CI) 3.743–7.801, p < 0.001], PS (HR 4.375, 95% CI 2.856–6.703, p < 0.001) and adjuvant chemotherapy (HR 1.476, 95% CI 1.028–2.119, p = 0.035) were risk factors for OS. Subgroup analysis showed that for patients with 8th edition stage IB NSCLC, 5-year OS was 87.6% in the observation group (n = 265) and 82.4% in the adjuvant group (p = 0.021). For patients with 8th edition stage IIA NSCLC, 5-year OS was 48.1% and 87.7% in the observation group and the adjuvant group (p < 0.001), respectively. For patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0, a better 5-year OS was seen in the adjuvant group (79.3% vs 91.6%, p = 0.001) By contrast, for patients with a PS score of ECOG 1, the 5-year OS was significantly improved in the observation group (58.6% vs 17.2%, p = 0.021).

Conclusion

The 8th edition of the AJCC staging identified the beneficiary population of platinum-based adjuvant chemotherapy in early-stage NSCLC. Moreover, patients with good PS (ECOG 0) benefited from adjuvant chemotherapy. A large prospective randomized clinical trial is needed to determine the real role of adjuvant chemotherapy in this setting.

Keywords

NSCLC Adjuvant chemotherapy Early stage The 8th TNM classification 

Supplementary material

432_2018_2801_MOESM1_ESM.jpg (26 kb)
Supplementary figure 1. KM curves of overall survival between patients treated with 4-course and more than 4-course adjuvant chemotherapy (JPG 26 KB)
432_2018_2801_MOESM2_ESM.jpg (27 kb)
Supplementary figure 2. KM curves of overall survival between patients had dose reduction of adjuvant chemotherapy or not (JPG 26 KB)
432_2018_2801_MOESM3_ESM.jpg (32 kb)
Supplementary figure 3. KM curves of overall survival in patients with different histology subtypes between two groups (JPG 31 KB)

References

  1. Arriagada R, Bergman B, Dunant A et al (2004) Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 350:351–360CrossRefGoogle Scholar
  2. Asamura H, Goya T, Koshiishi Y et al (2008) A Japanese lung cancer registry study: prognosis of 13,010 resected lung cancers. J orac Oncol 3(1):46–52Google Scholar
  3. Carbone E, Asamura, Takei H et al (2001) T2 tumors larger than five centimeters in diameter can be upgraded to T3 in non-small cell lung cancer. J Thorac Cardiovasc Surg 122:907–912CrossRefGoogle Scholar
  4. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Non-small Cell Lung Cancer Collaborative Group. BMJ.1995;311:899–909Google Scholar
  5. de Castria TB, da Silva EM, Gois AF, Riera R (2013) Cisplatin versus carboplatin in combination with third-generation drugs for advanced non-small cell lung cancer. Cochrane Database Syst Rev 16;(8):CD009256Google Scholar
  6. Detterbeck FC, Chansky K, Groome P et al (2016) The IASLC lung cancer staging project: methodology and validation used in the development of proposals for revision of the stage classification of NSCLC in the forthcoming (eighth) edition of the TNM classification of lung cancer. J Thorac Oncol 11:1433–1446CrossRefGoogle Scholar
  7. Douillard JY, Rosell R, De Lena M et al (2006) Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol 7:719–727CrossRefGoogle Scholar
  8. Eberhardt WE, Mitchell A, Crowley J, Kondo H, Kim YT, Turrisi A 3rd, Goldstraw P, Rami-Porta R, International Association for Study of Lung Cancer S, Prognostic Factors Committee ABM, Participating I (2015) The IASLC lung cancer staging project: proposals for the revision of the M descriptors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol 10:1515–1522.  https://doi.org/10.1097/JTO.0000000000000673 CrossRefPubMedGoogle Scholar
  9. Goldstraw P, Chansky K, Crowley J et al (2016) The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 11:39–51CrossRefGoogle Scholar
  10. Group NM-aC, Arriagada R, Auperin A et al (2010) Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet 375:1267–1277CrossRefGoogle Scholar
  11. Howingto JA, Blum MG, Chang AC et al (2013) Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed:American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:e278s–e313sCrossRefGoogle Scholar
  12. Jiang J, Liang X, Zhou X, Huang R, Chu Z (2007) A meta-analysis of randomized controlled trials comparing carboplatin-based to cisplatin-based chemotherapy in advanced non-small cell lung cancer. Lung Cancer 57(3):348–358CrossRefGoogle Scholar
  13. Morgensztern D, Du L, Waqar SN, Patel A, Samson P, Devarakonda S, Gao F, Robinson CG, Bradley J, Baggstrom M, Masood A, Govindan R, Puri V (2016) Adjuvant chemotherapy for patients with T2N0M0 NSCLC. J Thorac Oncol 11(10):1729–35.  https://doi.org/10.1016/j.jtho.2016.05.022 (Epub 2016 Jun 8)CrossRefPubMedPubMedCentralGoogle Scholar
  14. Nicholson AG, Chansky K, Crowley J, Beyruti R, Kubota K, Turrisi A, Eberhardt WE, van Meerbeeck J, Rami-Porta R, Staging PF, Committee AB, Participating I, Staging et al (2016) The international association for the study of lung cancer lung cancer staging project: proposals for the revision of the clinical and pathologic staging of small cell lung cancer in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol 11:300–311.  https://doi.org/10.1016/j.jtho.2015.10.008 CrossRefPubMedGoogle Scholar
  15. NSCLC Meta-analyses Collaborative Group (2010) Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet 375:1267–1277CrossRefGoogle Scholar
  16. Padilla J, Calvo V, Penalver JC et al (1997) Surgical results and prognostic factors in early non-small cell lung cancer. Ann Thorac Surg 63:324–326CrossRefGoogle Scholar
  17. Pignon JP, Tribodet H, Scagliotti GV et al (2008) Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 26:3552–3559CrossRefGoogle Scholar
  18. Roselli M, Mario i S, Ferroni P et al (2006) Postsurgical chemotherapy in stage IB non-small cell lung cancer: long-term survival in a randomized study. Int J Cancer 119(4):955–960CrossRefGoogle Scholar
  19. Saad AS, Ghali RR, Shawki MA (2017) A prospective randomized controlled study of cisplatin versus carboplatin-based regimen in advanced squamous nonsmall cell lung cancer. J Cancer Res Ther 13(2):198–203.  https://doi.org/10.4103/0973-1482.187287 CrossRefPubMedGoogle Scholar
  20. Siegel RL, Miller KD, Jemal A. Cancer Statistics (2018) CA Cancer J Clin 68:7–30CrossRefGoogle Scholar
  21. Strauss GM, Herndon JE 2nd, Maddaus MA et al (2008) Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol 26:5043–5051CrossRefGoogle Scholar
  22. The International Adjuvant Lung Cancer Trial Collaborative Group (2004) Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 350:351–360CrossRefGoogle Scholar
  23. Winton T, Livingston R, Johnson D et al (2005) Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 352:2589–2597CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital and InstitutePeking University School of OncologyBeijingPeople’s Republic of China

Personalised recommendations