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Article: Survival impact of postoperative therapy modalities according to margin status in non–small cell lung cancer patients in the United States
Title | Survival impact of postoperative therapy modalities according to margin status in non–small cell lung cancer patients in the United States |
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Authors | |
Keywords | incomplete resection lung cancer National Comprehensive Cancer Network (NCCN) adjuvant therapy postoperative therapy survival |
Issue Date | 2017 |
Citation | Journal of Thoracic and Cardiovascular Surgery, 2017, v. 154, n. 2, p. 661-672.e10 How to Cite? |
Abstract | © 2017 The American Association for Thoracic Surgery Objective Unlike complete (R0) resection guidelines, current National Comprehensive Cancer Network (NCCN) adjuvant therapy guidelines after incomplete (R1/R2) resection of non–small cell lung cancer (NSCLC) are based on low-level evidence. We attempted to validate them. Methods Patients with pathologic stage I-IIIA NSCLC from 2004 to 2011 in the National Cancer Database were stratified by margin status, NCCN-specified stage groupings, and adjuvant therapy exposure (none, radiotherapy, chemotherapy, or both). Five-year overall survival (OS) and hazard ratios, adjusted for patient and institutional characteristics, were compared. We used a parallel analysis of R0 resections to validate our methodology. Results We analyzed 3461 R1/R2, and 78,979 R0 resections. After R0 resection, the NCCN-recommended option was associated with the best survival across all stage groups, supporting our analytic approach. Patients with R1/R2 stage IA treated with radiation had a 26% OS, compared with 58% with no treatment (P =.003). In patients with stage IB/IIA(N0) R1/R2, radiation was associated with a 25% OS compared with 47% with no treatment (P =.025) and 62% with chemotherapy (P <.007). Chemoradiation was not associated with a survival benefit in either group. Patients with IIA(N1)/IIB and IIIA had better survival with chemotherapy or chemoradiation. No group had a survival benefit with radiation alone. Conclusions NCCN adjuvant therapy guidelines after complete resection, based on high-level evidence, are validated, but not guidelines for patients with incompletely resected early-stage NSCLC, which are based on low-level evidence. Monomodality postoperative radiotherapy was not validated for any stage. Specific studies are needed to determine optimal management after incomplete resection. |
Persistent Identifier | http://hdl.handle.net/10722/266788 |
ISSN | 2023 Impact Factor: 4.9 2023 SCImago Journal Rankings: 1.744 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Smeltzer, Matthew P. | - |
dc.contributor.author | Lin, Chun Chieh | - |
dc.contributor.author | Kong (Spring), Feng Ming | - |
dc.contributor.author | Jemal, Ahmedin | - |
dc.contributor.author | Osarogiagbon, Raymond U. | - |
dc.date.accessioned | 2019-01-31T07:19:35Z | - |
dc.date.available | 2019-01-31T07:19:35Z | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | Journal of Thoracic and Cardiovascular Surgery, 2017, v. 154, n. 2, p. 661-672.e10 | - |
dc.identifier.issn | 0022-5223 | - |
dc.identifier.uri | http://hdl.handle.net/10722/266788 | - |
dc.description.abstract | © 2017 The American Association for Thoracic Surgery Objective Unlike complete (R0) resection guidelines, current National Comprehensive Cancer Network (NCCN) adjuvant therapy guidelines after incomplete (R1/R2) resection of non–small cell lung cancer (NSCLC) are based on low-level evidence. We attempted to validate them. Methods Patients with pathologic stage I-IIIA NSCLC from 2004 to 2011 in the National Cancer Database were stratified by margin status, NCCN-specified stage groupings, and adjuvant therapy exposure (none, radiotherapy, chemotherapy, or both). Five-year overall survival (OS) and hazard ratios, adjusted for patient and institutional characteristics, were compared. We used a parallel analysis of R0 resections to validate our methodology. Results We analyzed 3461 R1/R2, and 78,979 R0 resections. After R0 resection, the NCCN-recommended option was associated with the best survival across all stage groups, supporting our analytic approach. Patients with R1/R2 stage IA treated with radiation had a 26% OS, compared with 58% with no treatment (P =.003). In patients with stage IB/IIA(N0) R1/R2, radiation was associated with a 25% OS compared with 47% with no treatment (P =.025) and 62% with chemotherapy (P <.007). Chemoradiation was not associated with a survival benefit in either group. Patients with IIA(N1)/IIB and IIIA had better survival with chemotherapy or chemoradiation. No group had a survival benefit with radiation alone. Conclusions NCCN adjuvant therapy guidelines after complete resection, based on high-level evidence, are validated, but not guidelines for patients with incompletely resected early-stage NSCLC, which are based on low-level evidence. Monomodality postoperative radiotherapy was not validated for any stage. Specific studies are needed to determine optimal management after incomplete resection. | - |
dc.language | eng | - |
dc.relation.ispartof | Journal of Thoracic and Cardiovascular Surgery | - |
dc.subject | incomplete resection | - |
dc.subject | lung cancer | - |
dc.subject | National Comprehensive Cancer Network (NCCN) | - |
dc.subject | adjuvant therapy | - |
dc.subject | postoperative therapy | - |
dc.subject | survival | - |
dc.title | Survival impact of postoperative therapy modalities according to margin status in non–small cell lung cancer patients in the United States | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1016/j.jtcvs.2017.03.085 | - |
dc.identifier.scopus | eid_2-s2.0-85018293294 | - |
dc.identifier.volume | 154 | - |
dc.identifier.issue | 2 | - |
dc.identifier.spage | 661 | - |
dc.identifier.epage | 672.e10 | - |
dc.identifier.eissn | 1097-685X | - |
dc.identifier.isi | WOS:000406775800075 | - |
dc.identifier.issnl | 0022-5223 | - |