초록접수 현황
| 16F-071 | 구연 발표 |
Impact of N2 Extent and Nodal Response on Survival after Trimodal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer
Hong Kwan Kim, MD, PhD¹, Jong Ho Cho, MD, PhD¹, Yong Soo Choi, MD, PhD¹, Jae Ill Zo, MD, PhD¹, Young Mog Shim, MD, PhD¹, Keunchil Park, MD, PhD², Myung-Ju Ahn, MD, PhD², Jin Seok Ahn, MD, PhD², Yong Chan Ahn, MD, PhD³, Hong Ryull Pyo, MD, PhD³, Joungho Han, MD, PhD⁴, Hojoong Kim, MD, PhD⁵, Jhingook Kim, MD, PhD¹
¹Department of Thoracic and Cardiovascular Surgery, ²Division of Hematology-Oncology, ³Department of Radiation Oncology, ⁴Department of Pathology, ⁵Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background : Mediastinal downstaging is an important prognostic factor of neoadjuvant concurrent chemoradiotherapy (CCRT) for stage IIIA-N2 non-small-cell lung cancer (NSCLC). We aimed to compare survival based on pre-CCRT mediastinal nodal extent and post-CCRT mediastinal nodal response in patients undergoing neoadjuvant CCRT for stage IIIA-N2 NSCLC.
Methods : A retrospective review of patients who underwent neoadjuvant CCRT followed by surgery for N2 disease was performed and overall survival (OS) and recurrence-free survival (RFS) were compared according to pre-CCRT mediastinal nodal extent and post-CCRT mediastinal nodal response. Extensive lymph node involvement was defined by short-axis diameter of lymph nodes > 2cm measured at computed tomography or involvement of 2 or more mediastinal nodal stations.
Results : From 2003 to 2013, 407 patients (mean age, 59 years; 314 men) underwent surgery after neoadjuvant CCRT for NSCLC with pathologically proven N2 disease. Seventy-nine patients (19%) had extensive N2 disease on pre-CCRT imaging tests. Post-CCRT nodal status was ypN0 in 155 patients (38%), ypN1 in 56 (14%), and ypN2 in 196 (48%). With a mean follow-up of 41 months, the 5-year OS and RFS rates were 61% and 42% in ypN0-1 and 40% and 13% in ypN2, respectively (OS, p=0.0032; RFS, p<0.0001). For patients with ypN0-1, the 5-year OS and RFS rates were 60% and 52% in extensive N2 and 61% and 40% in non-extensive N2, respectively(OS, p=0.8106; RFS, p=0.1218). For patients with ypN2, the 5-year OS and RFS rates were 22% and 12% in extensive N2 and 47% and 12% in non-extensive N2, respectively(OS, p=0.0403; RFS, p=0.4842).
Conclusion : Patients with pre-CCRT non-extensive N2 showed satisfactory OS regardless of post-CCRT N2 responsiveness. Patients who achieved mediastinal downstaging showed acceptable OS and RFS regardless of pre-CCRT N2 extensiveness. Considering heterogeneity of N2, the indication of neoadjuvant CCRT needs to be differentiated according to pre-CCRT mediastinal nodal extent and post-CCRT mediastinal nodal response.
Methods : A retrospective review of patients who underwent neoadjuvant CCRT followed by surgery for N2 disease was performed and overall survival (OS) and recurrence-free survival (RFS) were compared according to pre-CCRT mediastinal nodal extent and post-CCRT mediastinal nodal response. Extensive lymph node involvement was defined by short-axis diameter of lymph nodes > 2cm measured at computed tomography or involvement of 2 or more mediastinal nodal stations.
Results : From 2003 to 2013, 407 patients (mean age, 59 years; 314 men) underwent surgery after neoadjuvant CCRT for NSCLC with pathologically proven N2 disease. Seventy-nine patients (19%) had extensive N2 disease on pre-CCRT imaging tests. Post-CCRT nodal status was ypN0 in 155 patients (38%), ypN1 in 56 (14%), and ypN2 in 196 (48%). With a mean follow-up of 41 months, the 5-year OS and RFS rates were 61% and 42% in ypN0-1 and 40% and 13% in ypN2, respectively (OS, p=0.0032; RFS, p<0.0001). For patients with ypN0-1, the 5-year OS and RFS rates were 60% and 52% in extensive N2 and 61% and 40% in non-extensive N2, respectively(OS, p=0.8106; RFS, p=0.1218). For patients with ypN2, the 5-year OS and RFS rates were 22% and 12% in extensive N2 and 47% and 12% in non-extensive N2, respectively(OS, p=0.0403; RFS, p=0.4842).
Conclusion : Patients with pre-CCRT non-extensive N2 showed satisfactory OS regardless of post-CCRT N2 responsiveness. Patients who achieved mediastinal downstaging showed acceptable OS and RFS regardless of pre-CCRT N2 extensiveness. Considering heterogeneity of N2, the indication of neoadjuvant CCRT needs to be differentiated according to pre-CCRT mediastinal nodal extent and post-CCRT mediastinal nodal response.
책임저자: Jhingook Kim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
발표자: Hong Kwan Kim, E-mail : hkkimts@gmail.com