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Prognostic factors in neoadjuvant treatment followed by surgery in stage IIIA-N2 non-small cell lung cancer: a multi-institutional study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society)

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Abstract

Purpose

To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC).

Methods

A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method and compared using the log-rank test. Cox regression analysis was performed.

Results

Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5 months (5–128 months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0–pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen.

Conclusions

In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patients.

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Acknowledgements

The authors wish to thank David Saldaña, Thoracic Surgery of Hospital Universitario Ramón y Cajal, Madrid; Ignacio Muguruza Trueba, Thoracic Surgery of Hospital Universitario Rey Juan Carlos, Móstoles; Pedro López Castro, Thoracic Surgery of Hospital Germans Trias i Pujol, Badalona and Rafael Aguilo Espases, Thoracic Surgery of Hospital del Mar, Barcelona, for the collaboration in this study. The author wish to thank Bradley Londres for translating and editing this manuscript. The study was supported by the Radiation Oncology Clinical Research Group (GICOR) and the GOECP-SEOR (Oncologic Group for the Study of Lung Cancer-Spanish Society of Radiation Oncology).

Funding

The translation of this work was supported financially by the Spanish Society of Radiation Oncology.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez1, 1, Pozuelo de Alarcón, 28223, Madrid, Spain

    F. Couñago & E. del Cerro

  2. Universidad Europea de Madrid, Calle Tajo, s/n, Villaviciosa de Odón, 28670, Madrid, Spain

    F. Couñago & E. del Cerro

  3. Department of Radiation Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain

    S. Montemuiño & T. García-Cañibano

  4. Department of Radiation Oncology, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo Km9, Madrid, Spain

    M. Martin

  5. Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Choupana s/n, bloque d. Santiago de Compostela, A Coruña, Spain

    B. Taboada & P. Calvo-Crespo

  6. Department of Radiation Oncology, Hospital Universitario Rey Juan Carlos, C/Gladiolo s/n. Móstoles, Madrid, Spain

    M. P. Samper-Ots

  7. Department of Radiation Oncology, Hospital Universitario Clínico San Carlos, C/Prof, Martín Lagos s/n, Madrid, Spain

    P. Alcántara & J. Corona

  8. Department of Radiation Oncology, Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, S/N, 41013, Seville, Spain

    J. L. López-Guerra

  9. Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Av. del Dr. Josep Laporte, 2, 43204, Reus, Tarragona, Spain

    M. Murcia-Mejía

  10. Department of Radiation Oncology, Hospital Clinico Universitario Lozano Blesa, San Juan Bosco 15, Zaragoza, Spain

    M. López-Mata

  11. Department of Radiation Oncology, Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain

    J. Jové-Teixidó

  12. Department of Radiation Oncology, Instituto Valenciano de Oncologia, Carrer del Professor Beltrán Báguena, 8, 46009, Valencia, Spain

    M. Chust

  13. Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cadiz, Spain

    V. Díaz-Díaz & L. de Ingunza-Barón

  14. Department of Radiation Oncology, Hospital Central de la Defensa Gomez Ulla, Glorieta Ejército, 1, 28047, Madrid, Spain

    M. L. Couselo

  15. Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/Diego de Velázquez, 1, Pozuelo de Alarcón, 28223, Madrid, Spain

    J. Moradiellos, S. Amor & A. Varela

  16. Department of Radiation Oncology, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain

    M. M. Puertas

  17. School of Doctoral Studies and Research, Universidad Europea, Calle Tajo, s/n, Villaviciosa de Odón, 28670, Madrid, Spain

    I. J. Thuissard & D. Sanz-Rosa

  18. Department of Radiation Oncology, Hospital del Mar. Passeig Marítim, 25-29, 08003, Barcelona, Spain

    N. R. de Dios

  19. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    N. R. de Dios

Authors
  1. F. Couñago
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  2. S. Montemuiño
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  3. M. Martin
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  4. B. Taboada
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  5. P. Calvo-Crespo
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  6. M. P. Samper-Ots
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  7. P. Alcántara
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  8. J. Corona
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  9. J. L. López-Guerra
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  10. M. Murcia-Mejía
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  11. M. López-Mata
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  12. J. Jové-Teixidó
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  13. M. Chust
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  14. V. Díaz-Díaz
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  15. L. de Ingunza-Barón
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  16. T. García-Cañibano
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  17. M. L. Couselo
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  18. E. del Cerro
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  19. J. Moradiellos
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  20. S. Amor
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  21. A. Varela
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  22. M. M. Puertas
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  23. I. J. Thuissard
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  24. D. Sanz-Rosa
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  25. N. R. de Dios
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Corresponding author

Correspondence to F. Couñago.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The present study involved human participants, and it was conducted considering ethic responsibilities according to the World Medical Association and the Declaration of Helsinki.

Informed consent

The study was approved by the ethics committees of all participating hospitals. Informed consent statement was not necessary for retrospective study. Patients provided informed consent for treatment as per standard procedure at the individual institutions.

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Couñago, F., Montemuiño, S., Martin, M. et al. Prognostic factors in neoadjuvant treatment followed by surgery in stage IIIA-N2 non-small cell lung cancer: a multi-institutional study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society). Clin Transl Oncol 21, 735–744 (2019). https://doi.org/10.1007/s12094-018-1976-3

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  • DOI: https://doi.org/10.1007/s12094-018-1976-3

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