Efficacy of platinum-based adjuvant chemotherapy in T2aN0 stage IB non-small cell lung cancer

Seong Yong Park, Jin Gu Lee, Jieun Kim, Go Eun Byun, Mi Kyung Bae, Chang Young Lee, Dae Joon Kim, Kyung Young Chung, Seong Yong Park, Jin Gu Lee, Jieun Kim, Go Eun Byun, Mi Kyung Bae, Chang Young Lee, Dae Joon Kim, Kyung Young Chung

Abstract

Background: Although overall survival for non-small cell lung cancer (NSCLC) has increased, survival rate for pathologically staged T2aN0M0 stage IB NSCLC remains low. Adjuvant chemotherapy is not a standard treatment for stage IB NSCLC. Our purpose was to determine the efficacy of platinum-based adjuvant chemotherapy in stage IB NSCLC.

Methods: We retrospectively reviewed the medical records of 119 stage IB patients who underwent lobectomy and mediastinal lymph node dissection. Among these, 60 patients underwent platinum-based adjuvant chemotherapy (adjuvant group) and 59 did not receive chemotherapy (observation group).

Results: Participants had a mean age of 62.12 ± 11.51 years and 73 (61.3%) were male. The median follow-up period was 49.04 months. Mean age was higher in the observation group whereas patients in the adjuvant group had larger tumors, more dissected lymph nodes, and better performance status. The 5-year overall survival was 64.7% in the observation group and 88.2% in the adjuvant group (p = 0.010). The 5-year disease-free survival was 51.3% in the observation group and 74.0% in the adjuvant group (p = 0.011). In multivariate analysis, only platinum-based adjuvant chemotherapy was a risk factor for overall survival [hazard ratio (HR) = 0.428, p = 0.049] and disease-free survival (HR = 0.57, p = 0.043). In subset analysis, patients with a larger tumor (greater than 3.2 cm), moderate to poor differentiation, and good performance status (Eastern Cooperative Oncology Group, 0) benefitted from platinum-based adjuvant chemotherapy.

Conclusions: Platinum-based adjuvant chemotherapy for surgically treated stage IB NSCLC might offer better survival than observation alone. A large-scale randomized clinical trial is needed to validate these findings.

Figures

Figure 1
Figure 1
Survival curves. A. Overall survival curves according to adjuvant therapy. B. Disease-free survival curves according to adjuvant therapy.
Figure 2
Figure 2
Survival curves for subset analysis. A. Overall survival according to adjuvant therapy in patients with tumor size greater than or equal to 3.2 cm (n = 63). B. Overall survival according to the adjuvant therapy in patients with moderate to poor differentiation (n = 76). C. Overall survival according to the adjuvant therapy in patients with good performance status (n = 88).

References

    1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–249. doi: 10.3322/caac.20006.
    1. Lee JG, Lee CY, Bae MK, Byun CS, Kim DJ, Chung KY. Changes in the demographics and prognoses of patients with resected non-small cell lung cancer: a 20-year experience at a single institution in Korea. J Korean Med Sci. 2012;27:1486–1490. doi: 10.3346/jkms.2012.27.12.1486.
    1. Park SY, Lee HS, Jang HJ, Lee GK, Chung KY, Zo JI. Tumor necrosis as a prognostic factor for stage IA non-small cell lung cancer. Ann Thorac Surg. 2011;91:1668–1673. doi: 10.1016/j.athoracsur.2010.12.028.
    1. Goldstraw P, Crowley J, Chansky K. et al.The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007;2:706–714. doi: 10.1097/JTO.0b013e31812f3c1a.
    1. Arriagada R, Bergman B, Dunant A. et al.Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004;350:351–360.
    1. Winton T, Livingston R, Johnson D. et al.Vinorelbine plus cisplatin vs. observation in resected non–small-cell lung cancer. N Engl J Med. 2005;352:2589–2597. doi: 10.1056/NEJMoa043623.
    1. Douillard J, Rosell R, Delena M. et al.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. 2006;7:719–727. doi: 10.1016/S1470-2045(06)70804-X.
    1. Strauss GM, Herndon JE II, Maddaus MA. et al.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. 2008;26:5043–5051. doi: 10.1200/JCO.2008.16.4855.
    1. Oken MM, Creech RH, Tormey DC. et al.Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–656. doi: 10.1097/00000421-198212000-00014.
    1. Shim HS, Park IK, Lee CY, Chung KY. Prognostic significance of visceral pleural invasion in the forthcoming (seventh) edition of TNM classification for lung cancer. Lung cancer. 2009;65:161–165. doi: 10.1016/j.lungcan.2008.11.008.
    1. Lee JG, Cho BC, Bae MK. et al.Thoracoscopic lobectomy is associated with superior compliance with adjuvant chemotherapy in lung cancer. Ann Thorac Surg. 2011;91:344–348. doi: 10.1016/j.athoracsur.2010.09.031.
    1. Kato H, Ichinose Y, Ohta M. et al.A randomized trial of adjuvant chemotherapy with uracil–tegafur for adenocarcinoma of the lung. N Eng J Med. 2004;350:1713–1721. doi: 10.1056/NEJMoa032792.
    1. Hamada C, Tanake F, Ohta M. et al.Meta-analysis of postoperative adjuvant chemotherapy with tegafur-uracil in non-small-cell lung cancer. J Clin Oncol. 2005;23:4999–5006. doi: 10.1200/JCO.2005.09.017.
    1. Wakelee HA, Schiller JH, Gandara DR. Current status of adjuvant chemotherapy for stage IB non–small-cell lung cancer: implications for the New Intergroup Trial. Clin Lung Cancer. 2006;8:18–21. doi: 10.3816/CLC.2006.n.028.
    1. Park JH, Lee CT, Lee HW, Baek HJ, Zo JI, Shim YM. Postoperative adjuvant chemotherapy for stage I non-small cell lung cancer. Eur J Cardiothorac Surg. 2005;27:1086–1091. doi: 10.1016/j.ejcts.2005.01.039.
    1. Mineo TC, Ambrogi V, Corsaro V, Roselli M. Postoperative adjuvant therapy for stage IB non-small-cell lung cancer. Eur J Cardiothorac Surg. 2001;20:378–384. doi: 10.1016/S1010-7940(01)00779-5.
    1. Rami-Porta R, Ball D, Crowley J. et al.The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2007;2:593–602. doi: 10.1097/JTO.0b013e31807a2f81.
    1. Pignon JP, Tribodet H, Scagliotti GV. et al.Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008;26:3552–3559. doi: 10.1200/JCO.2007.13.9030.
    1. Jones DR, Daniel TM, Denlinger CE, Rundall BK, Smolkin ME, Wick MR. Stage IB nonsmall cell lung cancers: are they all the same? Ann Thorac Surg. 2006;81:1958–1962. doi: 10.1016/j.athoracsur.2005.12.054.
    1. Yoshida J, Nagai K, Asamura H. et al.Visceral pleura invasion impact on non-small cell lung cancer patient survival: its implications for the forthcoming TNM staging based on a large-scale nation-wide database. J Thorac Oncol. 2009;4:959–963. doi: 10.1097/JTO.0b013e3181a85d5e.
    1. Heon S, Johnson BE. Adjuvant chemotherapy for surgically resected non–small cell lung cancer. J Thorac Cardiovasc Surg. 2012;144:S39–S42. doi: 10.1016/j.jtcvs.2012.03.039.

Source: PubMed

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