Impact of preoperative radiation on survival of patients with T3N0 >7-cm nonesmall cell lung cancers treated with anatomic resection using the Surveillance, Epidemiology, and End Results database

Amy C. Moreno, Daniel Morgensztern, James B. Yu, Daniel J. Boffa, Roy H. Decker, Frank C. Detterbeck, Anthony W. Kim

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Background: Very large nonesmall cell lung cancers (NSCLC) remain a therapeutic challenge. The objective of this study was to evaluate the effect of surgery in the presence and absence of neoadjuvant radiation (NRT) on survival of patients with T3N0 >7-cm NSCLCs. Materials and methods: The Surveillance, Epidemiology, and End Results database was used to identify patients undergoing lobectomy or pneumonectomy for T3N0 NSCLC tumors >7 cm from 1999-2008. Patients were categorized into groups based on type of surgery performed and whether NRT was used. Five-year overall (OS) and lung cancerespecific survival (LCSS) were estimated by the Kaplan-Meier method and comparisons made using log-rank tests and Cox regression models. Results: There were 1301 patients evaluated, including 1232 undergoing primary surgical therapy (PST) and 69 receiving NRT. NRT was not associated with improvements in 5-y OS (48% versus 41%, P = 0.062) or LCSS (59% versus 52%, P = 0.116) compared with PST. Lobectomies were associated with better 5-y OS (43% versus 33%; P = 0.006) and LCSS (54% versus 43%, P = 0.005) compared with pneumonectomies. On multivariate analysis, NRT did not produce any significant advantage in OS (P = 0.242) and LCSS (P = 0.208). Pneumonectomies were associated with significantly worse OS (hazard ratio, 1.32; P = 0.007) and LCSS (hazard ratio, 1.38; P = 0.005) when compared with lobectomies. Conclusions: NRT, which most likely was a combination of chemotherapy and radiation, was not associated with improvements in OS or LCSS in patients with T3N0 >7-cm NSCLC compared with PST. When feasible, lobectomy appears more beneficial than pneumonectomy in terms of long-term survival for very large tumors.

Original languageEnglish
Pages (from-to)10-18
Number of pages9
JournalJournal of Surgical Research
Volume184
Issue number1
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

Keywords

  • Anatomic resection
  • Neoadjuvant radiation therapy
  • None-small cell lung cancer
  • SEER
  • T3
  • T3N0 tumors

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