Hofmann, Hans-Stefan and Braess, Jan and Leipelt, Susanne and Allgaeuer, Michael and Klinkhammer-Schalke, Monika and Szoeke, Tamas and Grosser, Christian and Pfeifer, Michael and Ried, Michael (2018) Multimodality therapy in subclassified stage IIIA-N2 non-small cell lung cancer patients according to the Robinson classification: heterogeneity and management. JOURNAL OF THORACIC DISEASE, 10 (6). pp. 3585-3594. ISSN 2072-1439, 2077-6624
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Background: Non-small cell lung cancer (NSCLC) with mediastinal lymph node involvement (N2) is a heterogeneous entity. The objective of this analysis is to investigate the results of treatment strategies for N2-positive patients. Methods: Retrospective study (2009-2014) of 104 consecutive patients with stage IIIA-N2 NSCLC classified according to the Robinson classification (IILAI-IIIA4) and treated within a multimodality treatment regime. Results: The Robinson subgroups were: IIIAI (n=27), IHA3 (n=60) and IHA4 (n=17). We had no stage I I I A2 samples because we did not perform an intraoperative frozen section of lymph nodes. Surgical resection with systematic lymph node dissection was performed in all patients with stage IIIAI (n=27). After chemotherapy or chemo-/radiotherapy, 53.3% of patients in stage II IA3 (n=32) and 11.7% of patients in stage IIIA4 (n=2) underwent surgery with curative intention. RO was achieved in 92.6% in stage IIIAI, 93.8% in stage IIIA3 and 100% in stage HIA4. The 30-day mortality was 3.2%. The overall median survival was 31.7 months (5-year survival was 30.5%). There were no significant differences (P=0.583) in survival regarding the Robinson subgroups. Patients who underwent tumour resection had significantly better median survival (39.8 vs. 19.6 months; P=0.014) compared to patients treated conservatively. Deviation from the interdisciplinary recommended therapy (12%) led to a reduced median survival (11.4 vs. 31.8 months; P=0.137). Conclusions: N2-patients should be subclassified according to the Robinson classification and discussed in the tumour board. Surgical resection should be recommended in specific cases of N2-disease (non-bulky, sensitivity to systemic treatment).
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | RANDOMIZED CONTROLLED-TRIAL; PREOPERATIVE CHEMOTHERAPY; INDUCTION CHEMOTHERAPY; TRIMODALITY THERAPY; COMPLETE RESECTION; PN2 DISEASE; PHASE-III; N2; RADIOTHERAPY; SURVIVAL; Non-small cell lung cancer (NSCLC); mediastinal lymph node; Robinson classification; tumour board; surgery; survival |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Abteilung für Thoraxchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 20 Feb 2020 08:39 |
| Last Modified: | 20 Feb 2020 08:39 |
| URI: | https://pred.uni-regensburg.de/id/eprint/14463 |
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