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Nodal stage of surgically resected non-small cell lung cancer and its effect on recurrence patterns and overall survival.

Publication ,  Journal Article
Varlotto, JM; Yao, AN; DeCamp, MM; Ramakrishna, S; Recht, A; Flickinger, J; Andrei, A; Reed, MF; Toth, JW; Fizgerald, TJ; Higgins, K; Zheng, X ...
Published in: Int J Radiat Oncol Biol Phys
March 15, 2015

PURPOSE: Current National Comprehensive Cancer Network guidelines recommend postoperative radiation therapy (PORT) for patients with resected non-small cell lung cancer (NSCLC) with N2 involvement. We investigated the relationship between nodal stage and local-regional recurrence (LR), distant recurrence (DR) and overall survival (OS) for patients having an R0 resection. METHODS AND MATERIALS: A multi-institutional database of consecutive patients undergoing R0 resection for stage I-IIIA NSCLC from 1995 to 2008 was used. Patients receiving any radiation therapy before relapse were excluded. A total of 1241, 202, and 125 patients were identified with N0, N1, and N2 involvement, respectively; 161 patients received chemotherapy. Cumulative incidence rates were calculated for LR and DR as first sites of failure, and Kaplan-Meier estimates were made for OS. Competing risk analysis and proportional hazards models were used to examine LR, DR, and OS. Independent variables included age, sex, surgical procedure, extent of lymph node sampling, histology, lymphatic or vascular invasion, tumor size, tumor grade, chemotherapy, nodal stage, and visceral pleural invasion. RESULTS: The median follow-up time was 28.7 months. Patients with N1 or N2 nodal stage had rates of LR similar to those of patients with N0 disease, but were at significantly increased risk for both DR (N1, hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.30-2.59; P=.001; N2, HR = 2.32, 95% CI: 1.55-3.48; P<.001) and death (N1, HR = 1.46, 95% CI: 1.18-1.81; P<.001; N2, HR = 2.33, 95% CI: 1.78-3.04; P<.001). LR was associated with squamous histology, visceral pleural involvement, tumor size, age, wedge resection, and segmentectomy. The most frequent site of LR was the mediastinum. CONCLUSIONS: Our investigation demonstrated that nodal stage is directly associated with DR and OS but not with LR. Thus, even some patients with, N0-N1 disease are at relatively high risk of local recurrence. Prospective identification of risk factors for local recurrence may aid in selecting an appropriate population for further study of postoperative radiation therapy.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

March 15, 2015

Volume

91

Issue

4

Start / End Page

765 / 773

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Lymph Nodes
  • Lung Neoplasms
  • Humans
  • Follow-Up Studies
 

Citation

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Varlotto, J. M., Yao, A. N., DeCamp, M. M., Ramakrishna, S., Recht, A., Flickinger, J., … Kelsey, C. R. (2015). Nodal stage of surgically resected non-small cell lung cancer and its effect on recurrence patterns and overall survival. Int J Radiat Oncol Biol Phys, 91(4), 765–773. https://doi.org/10.1016/j.ijrobp.2014.12.028
Varlotto, John M., Aaron N. Yao, Malcolm M. DeCamp, Satvik Ramakrishna, Abe Recht, John Flickinger, Adin Andrei, et al. “Nodal stage of surgically resected non-small cell lung cancer and its effect on recurrence patterns and overall survival.Int J Radiat Oncol Biol Phys 91, no. 4 (March 15, 2015): 765–73. https://doi.org/10.1016/j.ijrobp.2014.12.028.
Varlotto JM, Yao AN, DeCamp MM, Ramakrishna S, Recht A, Flickinger J, et al. Nodal stage of surgically resected non-small cell lung cancer and its effect on recurrence patterns and overall survival. Int J Radiat Oncol Biol Phys. 2015 Mar 15;91(4):765–73.
Varlotto, John M., et al. “Nodal stage of surgically resected non-small cell lung cancer and its effect on recurrence patterns and overall survival.Int J Radiat Oncol Biol Phys, vol. 91, no. 4, Mar. 2015, pp. 765–73. Pubmed, doi:10.1016/j.ijrobp.2014.12.028.
Varlotto JM, Yao AN, DeCamp MM, Ramakrishna S, Recht A, Flickinger J, Andrei A, Reed MF, Toth JW, Fizgerald TJ, Higgins K, Zheng X, Shelkey J, Medford-Davis LN, Belani C, Kelsey CR. Nodal stage of surgically resected non-small cell lung cancer and its effect on recurrence patterns and overall survival. Int J Radiat Oncol Biol Phys. 2015 Mar 15;91(4):765–773.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

March 15, 2015

Volume

91

Issue

4

Start / End Page

765 / 773

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Lymph Nodes
  • Lung Neoplasms
  • Humans
  • Follow-Up Studies