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Survival after radiation for stage I and II non-small cell lung cancer with positive margins.

Publication ,  Journal Article
Gulack, BC; Cox, ML; Yang, C-FJ; Speicher, PJ; Kara, HV; D'Amico, TA; Berry, MF; Hartwig, MG
Published in: J Surg Res
March 2018

BACKGROUND: There is limited data guiding treatment for positive margins following lobectomy for early-stage non-small cell lung cancer (NSCLC). Using data from the National Cancer Data Base, we sought to determine whether radiation therapy following lobectomy for stage I or II NSCLC was associated with improved overall survival in patients with positive margins. METHODS: Patients who underwent lobectomy without induction therapy for stage I or II NSCLC (1998-2006) with positive resection margins were selected. Patients were stratified by administration of radiation therapy following surgery, and overall survival was estimated using the Kaplan-Meier method. The association between radiation therapy and survival was adjusted for nonrandom treatment selection using Cox proportional hazards regression modeling. RESULTS: Positive margins were recorded in 1934 of 49,563 (3.9%) patients who underwent lobectomy for stage I or II NSCLC. Positive margin status was associated with significantly worse 5-year survival (34.5% versus 57.2%, P < 0.001). After selection of patients with positive margins and known radiation status and exclusion of patients who had upstaged disease or received radiation therapy for palliative indications, radiation therapy was used in 579 of 1579 patients (38.2%) but was not associated with a significant difference in the likelihood of death during subsequent follow-up (hazard ratio: 1.10, 95% confidence interval: 0.90, 1.35). CONCLUSIONS: Positive margins following lobectomy for stage I or II NSCLC are associated with reduced 5-year survival. Postsurgical radiation is not strongly associated with an improvement in overall survival among these patients.

Duke Scholars

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

March 2018

Volume

223

Start / End Page

94 / 101

Location

United States

Related Subject Headings

  • Surgery
  • Proportional Hazards Models
  • Pneumonectomy
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Logistic Models
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Gulack, B. C., Cox, M. L., Yang, C.-F., Speicher, P. J., Kara, H. V., D’Amico, T. A., … Hartwig, M. G. (2018). Survival after radiation for stage I and II non-small cell lung cancer with positive margins. J Surg Res, 223, 94–101. https://doi.org/10.1016/j.jss.2017.10.025
Gulack, Brian C., Morgan L. Cox, Chi-Fu Jeffrey Yang, Paul J. Speicher, H Volkan Kara, Thomas A. D’Amico, Mark F. Berry, and Matthew G. Hartwig. “Survival after radiation for stage I and II non-small cell lung cancer with positive margins.J Surg Res 223 (March 2018): 94–101. https://doi.org/10.1016/j.jss.2017.10.025.
Gulack BC, Cox ML, Yang C-FJ, Speicher PJ, Kara HV, D’Amico TA, et al. Survival after radiation for stage I and II non-small cell lung cancer with positive margins. J Surg Res. 2018 Mar;223:94–101.
Gulack, Brian C., et al. “Survival after radiation for stage I and II non-small cell lung cancer with positive margins.J Surg Res, vol. 223, Mar. 2018, pp. 94–101. Pubmed, doi:10.1016/j.jss.2017.10.025.
Gulack BC, Cox ML, Yang C-FJ, Speicher PJ, Kara HV, D’Amico TA, Berry MF, Hartwig MG. Survival after radiation for stage I and II non-small cell lung cancer with positive margins. J Surg Res. 2018 Mar;223:94–101.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

March 2018

Volume

223

Start / End Page

94 / 101

Location

United States

Related Subject Headings

  • Surgery
  • Proportional Hazards Models
  • Pneumonectomy
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Logistic Models
  • Humans
  • Female