This Article Full Text Full Text (PDF) All Versions of this Article: theoncologist.2009-0130v1 14/11/1106    most recent eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Google Scholar Articles by Moretti, L. Articles by Lu, B. PubMed PubMed Citation Articles by Moretti, L. Articles by Lu, B.

Lung Cancer

Prognostic Factors for Resected Non-Small Cell Lung Cancer with pN2 Status: Implications for Use of Postoperative Radiotherapy

^aDepartment of Radiation Oncology, ^bDepartment of Biostatistics, ^cDepartment of Medicine, and ^dDepartment of Thoracic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, USA

Key Words. Adjuvant radiotherapy • Non-small cell lung cancer • pN2 • Prognostic factors • Extracapsular extension

Correspondence: Bo Lu, M.D., Ph.D., Department of Radiation Oncology, Vanderbilt University Medical Center, 22nd at Pierce Avenue, TVC, Nashville, Tennessee, USA. Telephone: 615-322-2555; Fax: 616-343-3075; e-mail: Bo.lu{at}vanderbilt.edu

Received June 29, 2009; accepted for publication October 9, 2009; first published online in THE ONCOLOGIST Express on November 6, 2009.

Disclosures

Luigi Moretti: None; Davis S. Yu: None; Heidi Chen: None; David P. Carbone: None; David H. Johnson: None; Vicki L. Keedy: None; Joe B. Putnam, Jr.: None; Alan B. Sandler: None; Yu Shyr: None; Bo Lu: None.

Section editors Cesare Gridelli and Lecia Sequist have disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Background. For non-small cell lung cancer (NSCLC) patients with pN2 status, the use of postoperative radiotherapy (PORT) remains controversial. Here, we investigated the association between different clinicopathological features and postoperative therapy and local control and survival in patients with resected pN2 NSCLC.

Methods. We retrospectively analyzed 83 patients with pN2 NSCLC who underwent resection at Vanderbilt University Medical Center between 1994 and 2004. The relationship between 10 prognostic factors—gender, age at diagnosis, histology, tumor size, number of nodal stations involved, positive node number, surgical margin, extracapsular extension (ECE), and use of postoperative chemotherapy and PORT—and 2-year local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), recurrence-free survival (RFS), and overall survival (OS) rates was evaluated. Univariate and multivariate analyses were conducted using the Kaplan–Meier method and Cox proportional hazards ratios, respectively.

Results. On univariate analysis, PORT was significantly associated with greater LRFS, RFS, and OS rates, whereas chemotherapy was associated with a trend toward a higher OS rate. Negative surgical margins were predictive of a higher OS rate, and negative ECE was associated with higher LRFS and RFS rates. On multivariate analysis, only PORT and negative ECE were associated with a higher LRFS rate. On subgroup analysis, in negative ECE patients, PORT was significantly associated with a higher OS rate.

Conclusions. PORT is associated with a higher OS rate for patients with resected pN2 NSCLC with negative ECE but not with positive ECE. The absence of ECE may serve as a useful prognostic variable in the selection of pN2 NSCLC patients for PORT and warrants further investigation in randomized clinical trials.