P3.01-081 Overall Survival (OS) of Locally Advanced Non-Small Cell Lung Cancer (NSCLC) After Negative Invasive Mediastinal Staging

Abstract

According to current guidelines, invasive pre-operative staging should be performed with endoscopic ultrasound in NSCLC in suspected N2 disease. Due to its higher negative predictive value, in case of PET positive, CT enlarged mediastinal lymph nodes or central tumors, mediastinoscopy remains indicated when EBUS staging is negative. The aim of the current study was to evaluate OS of patients with locally advanced NSCLC who underwent surgical resection after negative EBUS and mediastinoscopy. The Institut de Cardiologie et Pneumologie de Quebec Biobank was queried for all patients with high probability of N2 disease or central tumors with negative EBUS and mediastinoscopy that underwent complete surgical resection (R0) between March 2009 and February 2017. Survival was examined using the Kaplan-Meier method with log rank analysis. Significance was set at p≤0.05. We identified 88 eligible patients (Table 1); 56 (64%) were male, mean age was 65±9 and 50% of the cases were adenocarcinoma. Regarding surgical modality, 1 (1%) patient underwent sublobar resection, 65 (74%) lobectomy or bilobectomy and 22 (25%) pneumonectomy. Among these, there were 11 (13%) pathological N2 cases. There was no 30-day mortality. During 8 years of follow-up, 30 patients died, including 20 (31%) in the lobectomy/bilobectomy group compared to 9 (41%) in the pneumonectomy group. We then identified 16 (80%) cancer-related deaths in the lobectomy/bilobectomy and 7 (78%) in the pneumonectomy group. Median OS of the entire cohort was 5.7 years, with no difference between groups (HR 1.29, CI 0.58-2.87, p=0.53). In our institutional database, patients locally advanced NSCLC had 13% incidence of pathological N2 disease and the OS was 5.7y. Our data supports surgical complete resection either by lobectomy or pneumonectomy in this group of patients with locally advanced disease.