Abstract
BackgroundAlthough 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.MethodsWe 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).ResultsParticipants 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.ConclusionsPlatinum-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.
Highlights
Overall survival for non-small cell lung cancer (NSCLC) has increased, survival rate for pathologically staged T2aN0M0 stage IB NSCLC remains low
Our experience provides an opportunity to retrospectively evaluate the efficacy of platinumbased adjuvant chemotherapy in stage IB NSCLC patients who underwent complete surgical resection and systemic mediastinal lymph node dissection
Only platinum-based adjuvant chemotherapy was a risk factor for overall survival [hazard ratio (HR) = 0.428, 95% confidence interval (CI) 0.184-0.998, p = 0.049; Table 2]
Summary
Overall survival for non-small cell lung cancer (NSCLC) has increased, survival rate for pathologically staged T2aN0M0 stage IB NSCLC remains low. Among patients who are candidates for surgical resection, the proportion with early stage nonsmall cell lung cancer (NSCLC) has increased due to surveillance programs and use of low-dose computed. Many randomized clinical trials have reported the efficacy of platinum-based adjuvant chemotherapy after surgical resection in stage II–IIIA lung cancer [5,6,7]. The efficacy of platinum-based adjuvant chemotherapy in stage IB NSCLC has been studied in a clinical trial [8] but the final results did not demonstrate clear benefits of adjuvant chemotherapy. Recent National Comprehensive Cancer Network (NCCN) guidelines recommend adjuvant chemotherapy with low-level evidence (category 2B) in patients with stage IB NSCLC and risk factors for poor survival. Our experience provides an opportunity to retrospectively evaluate the efficacy of platinumbased adjuvant chemotherapy in stage IB NSCLC patients who underwent complete surgical resection and systemic mediastinal lymph node dissection
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