Multimodal Therapy for T4 N2 Non–Small Cell Lung Cancer With Additional Ipsilateral Pulmonary Nodules

Abstract

BackgroundThe optimal treatment strategy for T4 non–small cell lung cancer (NSCLC) with additional intrapulmonary nodules in a different ipsilateral lobe (T4-Add) is not well characterized across clinical N stages. This study evaluated long-term survival of patients with T4-Add N2 NSCLC who received multimodal therapy including surgical resection and chemotherapy vs concurrent chemoradiation. MethodsPatients with T4-Add N2 M0 NSCLC in the National Cancer Database from 2010 to 2015 were included. Long-term survival was evaluated and compared between patients who underwent primary site surgical resection with chemotherapy and those who received concurrent chemoradiation by Kaplan-Meier analysis, Cox proportional hazards modeling, and propensity score matching on 9 common prognostic variables including comorbidities. ResultsOf the 499 patients diagnosed with T4-Add N2 M0 NSCLC who satisfied study eligibility criteria, 220 (44.1%) received primary site surgical resection with chemotherapy and 279 (55.9%) received chemoradiation. After multivariable adjusted Cox proportional hazards modeling, surgical resection with chemotherapy was associated with better long-term survival than chemoradiation. In a propensity score–matched analysis of 100 patients who received surgical resection with chemotherapy and 100 patients who received chemoradiation, patients who received surgical resection with chemotherapy had better 5-year overall survival. ConclusionsThe results of this national analysis of patients with T4 N2 NSCLC with additional nodules in a different ipsilateral lobe suggest that multimodal therapy including surgery may confer a survival benefit compared with chemoradiation alone. These findings support further evaluation of surgical resection as part of multimodal therapy for carefully selected patients with T4-Add N2 disease.