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Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis.

Publication ,  Journal Article
Yang, C-FJ; Kumar, A; Gulack, BC; Mulvihill, MS; Hartwig, MG; Wang, X; D'Amico, TA; Berry, MF
Published in: J Thorac Cardiovasc Surg
May 2016

OBJECTIVE: There are few studies evaluating whether to proceed with planned resection when a patient with non-small cell lung cancer (NSCLC) unexpectedly is found to have N2 disease at the time of thoracoscopy or thoracotomy. To help guide management of this clinical scenario, we evaluated outcomes for patients who were upstaged to pN2 after lobectomy without induction therapy using the National Cancer Data Base (NCDB). METHODS: Survival of NSCLC patients treated with lobectomy for clinically unsuspected mediastinal nodal disease (cT1-cT3 cN0-cN1, pN2 disease) from 1998-2006 in the NCDB was compared with "suspected" N2 disease patients (cT1-cT3 cN2) who were treated with chemotherapy with or without radiation followed by lobectomy, using matched analysis based on propensity scores. RESULTS: Unsuspected pN2 disease was found in 4.4% of patients (2047 out of 46,691) who underwent lobectomy as primary therapy for cT1-cT3 cN0-cN1 NSCLC. The 5-year survival was 42%, 36%, 21%, and 28% for patients who underwent adjuvant chemotherapy (n = 385), chemoradiation (n = 504), radiation (n = 300), and no adjuvant therapy (n = 858), respectively. Five-year survival of the entire unsuspected pN2 cohort was worse than survival of 2302 patients who were treated with lobectomy after induction therapy for clinical N2 disease (30% vs 40%; P < .001), although no significant difference in 5-year survival was found in a matched-analysis of 655 patients from each group (37% vs 37%; P = .95). CONCLUSIONS: This population-based analysis suggests that, in the setting of unsuspected pN2 NSCLC, proceeding with lobectomy does not appear to compromise outcomes if adjuvant chemotherapy with or without radiation therapy can be administered following surgery.

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Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

May 2016

Volume

151

Issue

5

Start / End Page

1380 / 1388

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Statistics, Nonparametric
  • Retrospective Studies
  • Respiratory System
  • Pneumonectomy
  • Perioperative Care
  • Neoplasm Staging
  • Neoplasm Invasiveness
 

Citation

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MLA
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Yang, C.-F., Kumar, A., Gulack, B. C., Mulvihill, M. S., Hartwig, M. G., Wang, X., … Berry, M. F. (2016). Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis. J Thorac Cardiovasc Surg, 151(5), 1380–1388. https://doi.org/10.1016/j.jtcvs.2015.12.028
Yang, Chi-Fu Jeffrey, Arvind Kumar, Brian C. Gulack, Michael S. Mulvihill, Matthew G. Hartwig, Xiaofei Wang, Thomas A. D’Amico, and Mark F. Berry. “Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis.J Thorac Cardiovasc Surg 151, no. 5 (May 2016): 1380–88. https://doi.org/10.1016/j.jtcvs.2015.12.028.
Yang C-FJ, Kumar A, Gulack BC, Mulvihill MS, Hartwig MG, Wang X, et al. Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis. J Thorac Cardiovasc Surg. 2016 May;151(5):1380–8.
Yang, Chi-Fu Jeffrey, et al. “Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis.J Thorac Cardiovasc Surg, vol. 151, no. 5, May 2016, pp. 1380–88. Pubmed, doi:10.1016/j.jtcvs.2015.12.028.
Yang C-FJ, Kumar A, Gulack BC, Mulvihill MS, Hartwig MG, Wang X, D’Amico TA, Berry MF. Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis. J Thorac Cardiovasc Surg. 2016 May;151(5):1380–1388.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

May 2016

Volume

151

Issue

5

Start / End Page

1380 / 1388

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Statistics, Nonparametric
  • Retrospective Studies
  • Respiratory System
  • Pneumonectomy
  • Perioperative Care
  • Neoplasm Staging
  • Neoplasm Invasiveness