Therapeutic Strategy For Resectable Stage Iiia/N2 Nsclc: A Single Center Experience

• Published in: Revista portuguesa de cirurgia cardio-torácica e vascular Vol. 27; no. 4; p. 266
• Main Authors: Batata, Rita, Carvalheiro, Catarina, Pantarotto, Marcos, Fontes, Maria Francisca, Cruz, Jorge
• Format: Journal Article
• Language: English
• Published: Portugal 01-10-2020
• Subjects: Female; Humans; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Neoplasm Recurrence, Local; Neoplasm Staging; Pneumonectomy; Retrospective Studies; Treatment Outcome
• ISSN: 0873-7215

Introduction Patients with resectable IIIA/ N2 disease have poor outcomes after resection alone and the optimal treatment remains controversial, justifying multimodal individualized interventions. Objectives This study aimed to evaluate the clinical outcomes of this specific setting of patients treated in our institution. Materials and Methods We retrospectively analyzed the medical records of all patients with pathological N2 disease operated with curative intent, between January 2012 and June 2020. All patients in our cohort treated prior to 2017 were re- -staged according to the 8th TNM edition. Results A total of 28 patients were enrolled, 15 were males, the median age was 68 years old (IQR 73-63) and 22 had a smoking history. Adenocarcinoma was the prevalent histology (n=21), with positive impact on survival (p=0.016). The majority of patients (n=20) had surgery up-front and adjuvant chemotherapy (SC); the remaining had surgery in combination with other treatment regimens (OT). The median follow-up time was 29 months (IQR 13.75 - 38). The median disease free survival (DFS) and overall survival (OS) were 14 (IQR 9.5 - 22) and 31.5 months (IQR 13.5-43.5), respectively. Three patients died of a non- -related cause.Twenty-four patients had an anatomical lung resection (bi/lobectomy=22, pneumonectomy=2) and 16 had minimally invasive surgery. All patients had complete resection. The median length of hospital-stay was 5.5 days (IQR 3.75-10.25). There was no 30-day mortality, and no morbidity associated with pneumonectomy. No OS difference was identified between anatomical and non-anatomical resection (p=0.456). The SC group analysis (n=20) revealed a DFS and OS similar to the overall group (n=28), with more than 50% of the patients alive at 36 months and a 65% 2-years OS; we found no correlation between survival and the number of mediastinal lymph-nodes removed (p=0.206), and no OS difference between pathological single-station versus multi-station N2 (p=0.631); thirteen patients had recurrence, 10% in the lymph nodes, with a median OS not significantly different between the recurrence and the non-recurrence subgroup (p=0.749). Conclusions Our results in general overlap those of literature. A worse survival would be expected in patients with N2 multi-station and a superior morbidity associated with pneumonectomy; we nevertheless regard our results with caution as bias can be introduced by the small sample size. Efforts must continue to identify the best treatment strategy for the IIIA-N2 patients as the prognosis is still unsatisfactory.