Influence of surgical interventions on survival in patients with stage IIIb non-small cell lung cancer (NSCLC): The Fox Chase Cancer Center (FCCC) experience.

Abstract

7067 Background: NSCLC patients (Pts) with T4 and/or N3 disease are categorized as stage IIIB NSCLC. Chemoradiation (CRT) is the standard of care for pts with dry (without malignant pleural effusion) stage IIIB NSCLC. Published results of Intergroup trial, INT 0139, suggests that lobectomy improves survival over CRT in stage IIIA disease. We evaluated the role of surgery in patients with dry stage IIIB to discern whether surgery would have a similar impact in technically resectable cases. Methods: Outcomes of NSCLC pts with dry IIIB disease, treated at FCCC between 01/2000 and 12/2008, were analyzed. Stage IIIB patients were dichotomized in two cohorts, those who had surgery versus those treated non-surgically. The propensity score method was used to balance the two cohorts for histology, age, sex, and smoking status. Kaplan-Meier estimators were used to compare overall survival (OS) between treatment cohorts. Results: The median age was 62 years (y) for the 194 pts with stage IIIb disease, of whom 51% were male. Most pts were Caucasian (85%) and smokers (87%). Sixty two pts had adenocarcinoma (32%), 68 squamous cell (35%) and 64 (33%) had NSCLC not otherwise specified. S was performed in 58 pts (29 lobectomies, 11 pneumonectomies and 18 other procedures) (30%) and 136 (70%) underwent CRT alone. After propensity score based weighting, there were no significant differences in patient characteristics, between the two cohorts. S was significantly superior to CRT (median OS 25 months (mos) vs. 16 mos, p=0.009). One, two and five y OS were 70%, 52% and 40% and 64%, 31% and 13% in the S group and CRT group, respectively. Progression-free survival and OS by T and N descriptors will be presented at the meeting. Conclusions: After propensity based weighting, OS of dry stage IIIB pts treated surgically was superior to pts treated with CRT. A fresh look at the role of surgery in select patients with dry stage IIIB disease may be warranted. No significant financial relationships to disclose.