Patterns of survival and recurrence after surgical treatment of early stage non–small cell lung carcinoma in the ACOSOG Z0030 (ALLIANCE) trial

Abstract

Objective Surgical resection has been the mainstay of curative treatment of early stage lung cancer in selected patients. We evaluated survival and patterns of recurrence after surgical resection for early stage lung cancer from the ACOSOG Z0030/Alliance trial. Methods 1018 patients in the Z0030 trial were analyzed according to clinical T stage. Differences between groups were compared using the two-sample rank test or chi-square test. Logrank test and Cox proportional hazards regression were used to compare survival and recurrence. To compare patients who underwent open versus VATS resections, propensity-score matched analysis was performed. 752 patients (66 VATS and 686 open) were classified into 5 equal-sized propensity score groups. Proportional hazards regression was used to compare these outcomes. Two-sided p-values<0.05 were considered statistically significant. Results There were 578 patients with cT1 tumors and 440 patients with cT2 tumors. Median follow-up was 6.7 years. Median overall survival was 9.1 years (T1) and 6.5 years (T2). Overall survival at 5 years was 72% (T1) and 55% (T2). Local recurrence-free survival at 5 years was 95% (T1) and 91% (T2) (p=0.015). Among T1 patients, 4.2% (23/542) had local recurrences, while 7.3% (30/409) of those with T2 tumors had local failure. There was no difference in the development of new primary tumors between T1 and T2 groups. In the propensity-score matched analysis of VATS versus open lobectomy patients, there was no difference in overall survival, disease-free survival, and freedom from development of a new primary tumor. Conclusions Results of patients with resected early stage NSCLC from a large-scale, multicenter trial serve as benchmarks against which to compare non-surgical therapies for early stage lung cancer. Propensity-score matched analysis shows no difference in survival between the VATS and open lobectomy patients.

Adaptive Neoadjuvant Chemotherapy Guided by 18 F-FDG PET in Resectable Non–Small Cell Lung Cancers: The NEOSCAN Trial

“…Despite this, 5-year overall survival rates even for the earliest stage NSCLCs remain poor: 72% with primaries ≤ 3 cm (T1a) and 55% with tumors > 3 cm (T1b). 1 The majority of patients that die after NSCLC resection do so from distant relapse, hypothesized to be caused by micrometastatic disease present at surgery. Perioperative cisplatin-based chemotherapy (neoadjuvant or adjuvant) decreases the risk of death over surgery alone and is a standard-of-care.…”

Electro-physiological evidence of intercostal nerve injury after thoracotomy: an experimental study in a sheep model

“…As an alternative approach to thoracotomy, video-assisted thoracoscopic (VATS) lobectomy has been increasingly adopted for treatment of early-stage NSCLC and is associated with reduced postoperative complications, equal oncological efficacy and long-term outcomes in comparison to open lobectomy (17,18). In this minimally invasive approach, anatomic lobectomy and mediastinal lymph node dissection or sampling are performed using one, two or three ports without retractor use or rib spreading (19).…”

Körperstereotaxie und Lobektomie im randomisierten Vergleich beim NSCLC Stadium I – endlich Level-I-Evidenz?

“…Eine bessere Standardisierbarkeit und sichere Implementierung der Strahlentherapie auf hohem Niveau "in der Breite" könnte folglich zumindest teilweise die sehr guten Ergebnisse der SBRT erklären. Zweitens wissen wir, dass sowohl SBRT als auch Lobektomie erfolgreiche lokale Therapieverfahren darstellen und die Mehrzahl der Rezidive distant auftreten [9,10]. Ob vor diesem Hintergrund eine weitere Intensivierung der lokalen Therapie über das bisherige Niveau der SBRT hinaus die Überlebenschancen tatsächlich weiter verbessern kann oder ob nicht zusätzliche Toxizität den potentiellen Benefit wieder zunichtemacht, ist durchaus zu bedenken [11], muss aber weiterhin untersucht werden.…”