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31st Annual Meeting Abstracts: The Influence of Induction Chemotherapy in Surgical Resected pT4 Lung Cancer
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20. The Influence of Induction Chemotherapy in Surgical Resected pT4 Lung Cancer
L. Spaggiari1, M. D'aiuto1, G. Veronesi1, F. Leo1, D. Galetta1, R. Gasparri1, M. E. Leon2, G. Pelosi3, T. M. De Pas4, F. De Braud4. 1Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy, 2Division of Statistic, European Institute of Oncology, Milan, Italy, 3Division of Pathology, European Institute of Oncology, Milan, Italy, 4Division of Oncology, European Institute of Oncology, Milan, Italy,
BACKGROUND: To evaluate in a continuos series of pT4 lung cancer: a) impact of induction chemotherapy (IndCT) on postoperative outcome, and b) survival; c) survival based on pathological nodal status with or without IndCT.
METHODS: Retrospective study. Fisher’s exact test for postoperative outcome analysis; survival calculated by Kaplan Meier method and log-rank test; Cox method for multivariate analysis.
RESULTS: Between May 1998 until April 2004, 62 patients with pT4 (superior vena cava, n=12; trachea, n=7; aorta, n=5; left atrium, n=7; pulmonary artery, n=3; vertebral body, n=4; innominate vein, n=2; multiple nodules, n=22) non small-cell lung cancer were operated on. Thirty-six patients (58%) underwent IndCT. Nodal status was N0 in 17 patients, N1 in 17, and N2 in 28, respectively. Postoperative morbidity-mortality rates were 30% and 11% respectively. Five-year survival rate was 32% (median, 15 months). IndCT did not influence postoperative morbidity (p=0.26) and mortality (p=0.43). Concerning survival, neither IndCT (p=0.55), nor nodal status (i.e. pN0-N1 group versus pN2 group - p=0.46) influence the prognosis. However, patients with best prognosis were those with pN0-N1 after IndCT. Completeness of resection didn’t influence survival. At multivariate analysis was not identified any prognostic factor.
CONCLUSIONS: Patients with pT4 lung cancer can benefit from surgical resection; IndCT does not increase the postoperative morbidity-mortality. The best candidates are those without mediastinal lymph-nodes involvement treated with IndCT.
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