Analysis of patients with locally advanced NSCLC after induction therapy: Importance of nodal downstaging, and prognostic factors for survival.

Le résumé fourni par la source

e18528 Background: NSCLC locally advanced still remains controversial with regard to their treatment. Stages III-A and III-B not N3 are susceptible of receiving induction chemotherapy prior to surgery. Previous studies confirms nodal downstaging in N2 patients as the main prognosis factor of survival. Our objective is to analyze the characteristics of these patients and to define survival prognostic factors, mainly in N2 patients. Methods: Retrospective, observational study of patients treated with induction therapy between 2005 and 2013. We also include those who finally not were operated due to progression during induction or conditions of inoperability. Results: 52 Patients have been included. 50 smokers and 2 not. Medium pack year 45 (10-120). 28 patients had adenocarcinoma, 6 large-cell carcinoma and 18 squamous cell carcinoma. 28 tumors were located in RUL, 6 in RLL, 9 in LUL, 5 in LLL and 4 were hilar. 48 patients received platinum-based doublet CT and 4 CT/RT treatment. 42 patients were N2 confirmed by mediastinoscopy, 7 were T4N0, 2 T4N1 and 1 T2N3. They were achieved by radiological criteria 1 CR (1.9%), 26 PR (50%), 12 SD (23.1%) and 13 patients PD (25%). 34 patients (65.4%) were selected for surgery, although 2 were rejected by inoperability. 23 lobectomies (72%), 7 pneumonectomies (22%), 1 segmentectomy (3%) and 1 atypical resection (3%) were performed. 2 patients (6.2%) died in the perioperative period . 2 complete responses were observed in pathological analysis (6.3%), 16 (50%) partial responses and 14 stable diseases (43.75%). Median PFS was 9.36 months (5.9-12.7 and median of OS was 19.1 months (15.1-23). 23 Patients N2 underwent surgery and 14 (60.9%) downstage nodal status. Survival at 18 months was significantly higher in the downstaging group (66.7% vs. 16.7%). Multivariate analysis showed as independent predictors of survival downstaging (p = 0.00493), non-squamous histology (p = 0.0367) and clinical response to treatment (p = 0.0005). Conclusions: Downstaging continues to be the main prognostic factor for survival in patients undergoing induction therapy prior to surgery. Survival is also better in patients with clinical response to treatment.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.