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Adjuvant Chemotherapy for Patients with T2N0M0 NSCLC

Journal of Thoracic Oncology

Abstract

Background

Adjuvant chemotherapy improves survival in patients with completely resected stage II and III NSCLC. However, its role in patients with stage IB NSCLC disease remains unclear. We evaluated the role of adjuvant chemotherapy in a large data set of patients with completely resected T2N0M0 NSCLC.

Methods

Patients with pathologic stage T2N0M0 NSCLC who underwent complete (R0) resection between 2004 and 2011 were identified from the National Cancer Data Base and classified into four groups based on tumor size: 3.1 to 3.9 cm, 4 to 4.9 cm, 5 to 5.9 cm, and 6 to 7 cm. Patients who died within 1 month after their operation were excluded. Survival curves were estimated by the Kaplan-Meier product-limit method and compared by log-rank test.

Results

Among the 25,267 patients who met the inclusion criteria, there were 4996 (19.7%) who received adjuvant chemotherapy. Adjuvant chemotherapy was associated with improved median and 5-year overall survival compared with observation for all tumor size groups. In patients with T2 tumors smaller than 4 cm, adjuvant chemotherapy was associated with improved median and 5-year overall survival in univariate (101.6 versus 68.2 months [67% versus 55%], hazard ratio [HR] = 0.66, 95% confidence interval [CI]: 0.61–0.72, p < 0.0001) and multivariable analysis (HR = 0.77, 95% CI: 0.70–0.83, p < 0.001) as well as propensity-matched score (101.6 versus 78.9 months [68% versus 60%], HR = 0.75, 95% CI: 0.70–0.86; p < 0.0001).

Conclusions

In patients with completely resected T2N0M0, adjuvant chemotherapy is associated with improved survival in all tumor size groups. The benefit in patients with tumors smaller than 4 cm strongly suggests a role for chemotherapy in this patient population and counters its current status as an exclusion criteria for adjuvant trials.

Keywords: NSCLC, Adjuvant chemotherapy, Stage I, National Cancer Data Base.

Footnotes

a Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri

b Department of Surgery, Washington University School of Medicine, St. Louis, Missouri

c Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri

d Division of Radiation Therapy, Washington University School of Medicine, St. Louis, Missouri

Corresponding author. Address for correspondence: Daniel Morgensztern, MD, Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8056, St. Louis, MO 63110.

Disclosure: Dr. Morgensztern reports personal fees from Celgene, Genentech, Bristol-Myers Squibb, Heat Biologics, and Boehringer Ingelheim outside the submitted work. Dr. Waqar reports a grant from the National Institutes of Health (1 UM1 CA186704-01) outside the submitted work. Dr. Bradley reports an ownership interest in and research funding from ViewRay, personal fees from Varian Proton, and institutional research funding from Mevion Medical Systems outside the submitted work. Dr. Govindan reports personal fees from Boehringer Ingelheim, Pfizer, Merck, Clovis, Helsinn Healthcare, Glaxo Smith Kline, Celgene, Bayer, and Roche and compensation for travel, accommodation, and expenses from StemCentrx outside the submitted work. Dr. Robinson reports personal fees and an ownership interest and advisory role in Radialogica, personal fees from Variant, grants from Elekta and Varian Medical Systems outside the submitted work. Dr. Baggstrom reports being the site principal investigator of a clinical trial at Novartis, Merck, Wyeth, Imclone, Boehringer Ingelheim, Eli Lilly, Bristol-Myers Squibb, Endocyte, Astex, Onyx, CtyRx, Millenium Pharmaceuticals, Genentech, Academic and Community Cancer Research United, AstraZeneca, MedImmune, and GlaxoSmithKline outside the submitted work. The remaining authors declare no conflict of interest.