초록접수 현황
| 16F-198 | 구연 발표 |
Pattern of Recurrence After Trimodality Therapy (Neoadjuvant Chemoradiotherapy and Surgery) In Stage IIIa(N2) Lung Cancer
Junghee Lee¹, Hong-Kwan Kim², Yong Soo Choi², Jong Ho Cho², Jae Ill Zo², Young Mog Shim², Su Min Shin², Jhingook Kim²
¹Department of Thoracic and Cardiovascular Surgery, Armed Forces Daejeon Hospital, Daejeon, Korea, ²Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background : To understand the dynamics of recurrence is mandatory to improve the treatment outcome in IIIa(N2) non-small cell lung cancer (NSCLC). We investigated the timing and patterns of recurrence after treatment of IIIA(N2) NSCLC with trimodality therapy.
Methods : An institutional database of consecutive patients between 1997 and 2013 (N = 574) was reviewed retrospectively. Eligibility were histologically confirmed N2 disease preoperatively and completion of a planned trimodality therapy.
Results : The 5-year overall survival rate was 47% and the 5-year recurrence free survival rate was 29%. Among the 299 patients (52.1% of total) who experienced recurrence, 26 (8.7%) had loco-regional recurrences and 248 (82.9%) had distant. The most frequent sites of distant metastases were lung (n=102, 41%), brain (n=63, 25%), and bone (n=63, 25%). The hazard rate function for the overall recurrence showed the peak at approximately 8 months after surgery then the down-slope pattern before 38 months. A similar risk pattern was found in distant metastases but steady risk pattern was detected in loco-regional recurrence. In individual organs, patterns were not different, however, earlier peak at approximately 5 months presented in brain metastasis. A comparison of histology showed that adenocarcinoma exhibited higher recurrence hazard rate than squamous cell carcinoma with similar pattern of recurrence (p=0.03). The status of nodal clearance after induction therapy exhibited that ypN2 patients (n= 229, 39.9%) had highest hazard rate (p=0.03). The recurrence hazard rate of ypN0 was approximately one of third of ypN2 at peak.
Conclusion : The hazard rate of loco-regional failure after trimodality therapy was low. But the hazard rate of distant metastasis was considerably high yet and shifted to left with the peak within 12 moths after surgery. This study guides the intensive surveillance immediate after completion of trimodality therapy to identify risk groups of early recurrence and to develop therapeutic strategy.
Methods : An institutional database of consecutive patients between 1997 and 2013 (N = 574) was reviewed retrospectively. Eligibility were histologically confirmed N2 disease preoperatively and completion of a planned trimodality therapy.
Results : The 5-year overall survival rate was 47% and the 5-year recurrence free survival rate was 29%. Among the 299 patients (52.1% of total) who experienced recurrence, 26 (8.7%) had loco-regional recurrences and 248 (82.9%) had distant. The most frequent sites of distant metastases were lung (n=102, 41%), brain (n=63, 25%), and bone (n=63, 25%). The hazard rate function for the overall recurrence showed the peak at approximately 8 months after surgery then the down-slope pattern before 38 months. A similar risk pattern was found in distant metastases but steady risk pattern was detected in loco-regional recurrence. In individual organs, patterns were not different, however, earlier peak at approximately 5 months presented in brain metastasis. A comparison of histology showed that adenocarcinoma exhibited higher recurrence hazard rate than squamous cell carcinoma with similar pattern of recurrence (p=0.03). The status of nodal clearance after induction therapy exhibited that ypN2 patients (n= 229, 39.9%) had highest hazard rate (p=0.03). The recurrence hazard rate of ypN0 was approximately one of third of ypN2 at peak.
Conclusion : The hazard rate of loco-regional failure after trimodality therapy was low. But the hazard rate of distant metastasis was considerably high yet and shifted to left with the peak within 12 moths after surgery. This study guides the intensive surveillance immediate after completion of trimodality therapy to identify risk groups of early recurrence and to develop therapeutic strategy.
책임저자: Jhingook Kim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
발표자: Junghee Lee, E-mail : smctsresident@gmail.com