UPFRONT SURGERY AS FIRST-LINE TREATMENT IN PATHOLOGICAL N2 NON-SMALL CELL LUNG CANCER

Abstract

TYPE: Abstract TOPIC: Lung Cancer PURPOSE: Multimodality therapy offers highest chance of improving prognosis in pN2 NSCLC. PURPOSE: to determine the long-term clinical outcomes and prognostic variables associated with upfront surgery as first-line therapy in pN2. METHODS: Retrospective evaluation of pN2 NSCLC underwent surgery (2007-2017). Patients with concurrent malignancies, neoadjuvant therapy; partial surgical resection; and insufficient data were excluded. Multidisciplinary team devised treatment methods for biopsy-confirmed N2 disease. Upfront surgery was considered if initial tumour was resectable, mediastinal nodal metastases were limited to single station, and there was no evidence of extra-nodal tumour invasion. RESULTS: Cox proportional hazards analysis revealed that older age and number of comorbidities were substantially linked with poorer OS. Mean duration of follow-up was 39.6 24.7 months. At conclusion of follow-up , 127 (44.6%) patients had died. Median overall survival (OS) for induction chemotherapy group was 49 months [95%CI: 38–70 months], and 5-year OS rate was 44.4%. Median and 5-year OS for patients who underwent upfront surgery were 66 months (95%CI: 40–119) and 66.3%, respectively. No statistically significant differences in treatment techniques were observed (p=0.48). At 5-years, DFS for induction chemotherapy was 17% (95%CI: 11–25) and upfront surgery was 22% (95%CI: 9–32%); there were no statistically significant differences between groups (p = 0.93). No significant variations in survival were identified according to clinical N status (OS, p=0.36; DFS, p=0.65). CONCLUSIONS: In patients with pN2 NSCLC, upfront surgery as first-line therapy resulted in favourable clinical results. CLINICAL IMPLICATIONS: In resectable N2 NSCLC, upfront surgery should be considered as one of the multimodality treatment choices. DISCLOSURE: Nothing to declare. KEYWORD: lung cancer