Comparison of Treatment Strategies for Patients With Clinical Stage T1–3/N2 Lung Cancer

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  • a Division of Thoracic Surgery, Department of Surgery, and
  • b Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua;
  • c School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung;
  • d Institute of Genomics and Bioinformatics, and
  • e National Chung Hsing University, Taichung;
  • f School of Medicine, Chung Shan Medical University, Taichung; and
  • g Center for General Education, Ming Dao University, Changhua, Taiwan.
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Background: The therapeutic strategies for clinical stage T1–3N2 (cT1–3N2) lung cancer are controversial. For operable tumors, treatment can vary by center, region, and continent. This study aimed to identify the optimal therapeutic method and type of surgical strategy for cT1–3N2 lung cancer. Methods: This retrospective evaluation analyzed the records of 17,954 patients with cT1–3N2 lung cancer treated in 2010 through 2015 from the SEER database. The effects of different therapeutic methods and types of surgical strategies on overall survival (OS) were assessed. Univariate and multivariate analyses were performed using a Cox proportional hazards model. Results: The 5-year OS rates were 27.7% for patients with T1N2 disease, 21.8% for those with T2N2 disease, and 19.9% for T3N2 disease. Neoadjuvant therapy plus operation (OP) plus adjuvant therapy, and OP plus adjuvant therapy, provided better 5-year OS rates than OP alone or concurrent chemoradiotherapy (34.1%, 37.7%, 29.3%, and 16.1%, respectively). In the T1N2, T2N2, and T3N2 groups, lobectomy provided better 5-year OS than pneumonectomy, sublobectomy, and no surgery. Both univariate and multivariate analyses showed that young age, female sex, well-differentiated histologic grade, adenocarcinoma cell type, neoadjuvant and adjuvant therapy, lobectomy, and T1 stage were statistically associated with better 5-year OS rates. Conclusions: In cT1–3N2 lung cancer, multimodal treatments tended to provide better 5-year OS than OP alone or concurrent chemoradiotherapy. In addition, lobectomy was associated with better survival than other operative methods.

Submitted May 6, 2019; accepted for publication August 30, 2019.

Author contributions: Study concept and design: Y.F. Cheng, Wang. Technical design and analysis of data: Hung, Chen, C.Y. Cheng. Data acquisition, interpretation, and analysis: C.H. Lin, S.H. Lin.

Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Bing-Yen Wang, MD, PhD, Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua City, Changhua County 500, Taiwan. Email: thomas21917@hotmail.com
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