The Survival Efficiency of Initial Surgical Treatment in Stage IIIa-N2 Positive Non-Small Cell Lung Cancer

Abstract

​ Objective: The role of surgical treatment in the multimodal treatment of stage IIIA-N2 positive non-small cell lung cancer (NSCLC) patients is a matter of debate. We aim to investigate initial surgical treatment's survival efficiency in patients with IIIA N2 positive NSCLC.Methods: The patients treated for stage IIIA N2 positive NSCLC in a single center between January 2009 and December 2014 were retrospectively analyzed. A total of 134 patients with 5 cm tumors in diameter or less and without involvements of the chest wall, mediastinal pleura, phrenic nerve, recurrent laryngeal nerve, pericardium, heart, diaphragm, vertebra, esophagus, large vessel invasion, and satellite nodule were detected. Of these patients, initial surgical treatment before chemoradiotherapy was performed in 72 (Group 1), while definitive concurrent chemoradiotherapy was performed in 62 patients (Group 2). Each patient's gender, age, physical performance status, tumors size, pathological diagnosis, lung resection types, and long-term survival data were evaluated.Results: No statistically significant difference was found in patients' gender, physical performance, tumor size, and tumor histology. Survival rates were higher among patients aged ≤65 years and higher in Group 1 than Group 2. While one-, three, five-, and seven-year survival rates were detected as 86.1%, 62.5%, 41.6%, and 31% in Group 1, respectively, the rates were observed to be as 77.4%, 30.6%, 10.8%, and 6.7% in Group 2, respectively. However, no difference was seen between patients' survival rates with single and multiple ipsilateral mediastinal lymph node metastases.Conclusion: Despite those advocating surgical treatment after neoadjuvant chemotherapy in treating stage IIIA N2 positive patients, others supporting surgical treatment should initially be performed. When conducted as the first step, surgical treatment achieves significant increases in survival.