Surgically Managed Clinical Stage IIIA-Clinical N2 Lung Cancer in The Society of Thoracic Surgeons Database

• Type of Material: Article
• Authors: Daniel Boffa, Yale New Haven Hospital; Felix Fernandez, Emory University; Sunghee Kim, Duke Clinical Research Institute; Andrzej Kosinski, Duke Clinical Research Institute; Mark W. Onaitis, University of California; Patricia Cowper, Duke Clinical Research Institute; Jeffrey P. Jacobs, Johns Hopkins All Children’s Heart Institute; Cameron D. Wright, Massachusetts General Hospital; Joe B. Putnam, Baptist MD Anderson Cancer Center; Anthony P. Furnary, Starr-Wood Cardiac Group
• Language: English
• Date: 2017-08-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 The Society of Thoracic Surgeons
• Final Published Version (URL): http://dx.doi.org/10.1016/j.athoracsur.2017.02.031
• Title of Journal or Parent Work: Annals of Thoracic Surgery
• ISSN: 0003-4975
• Volume: 104
• Issue: 2
• Start Page: 395
• End Page: 403
• Keywords: Cardiovascular System & Cardiology; CHEMOTHERAPY; MORTALITY; Cardiac & Cardiovascular Systems; PHASE-III; RESECTION; Respiratory System; RANDOMIZED CONTROLLED-TRIAL; PREDICTORS; Surgery; Life Sciences & Biomedicine; RADIOTHERAPY; Science & Technology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Background The role of surgical resection in patients with clinical stage IIIA–N2 positive (cIIIA-N2) lung cancer is controversial, partly because of the variability in short- and long-term outcomes. The objective of this study was to characterize the management of cIIIA-N2 lung cancer in The Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD). Methods The STS-GTSD was queried for patients who underwent operations for cIIIA-N2 lung cancer between 2002 and 2012. A subset of patients aged older than 65 years was linked to Medicare data. Results Identified were 3,319 surgically managed, cIIIA-N2 patients, including 1,784 (54%) treated with upfront resection (treatment naïve upfront surgery group, and 1,535 (46%) with induction therapy. A positron emission tomography scan was documented in 93% of patients, and 51% of patients were coded in STS-GTSD as having undergone invasive mediastinal staging. Nodal overstaging (cN2→pN0/N1) was observed in 43% of upfront surgery patients. Lobectomy was performed in 69% of patients and pneumonectomy in 11%. Operative mortality was similar between patients treated with upfront surgery (1.9%) and induction therapy (2.5%, p =.2583). The unadjusted Kaplan-Meier estimate of 5-year survival of cIII-N2 patients treated with induction therapy then resection was 35%. Conclusions STS surgeons achieve excellent short- and long-term results treating predominantly lobectomy-amenable cIIIA-N2 lung cancer. However, prevalent overstaging and abstention from induction therapy suggest “overcoding” of false positives on imaging or variable compliance with current guidelines for cIIIA-N2 lung cancer. Efforts are needed to improve clinical stage determination and guideline compliance in the GTSD for this cohort.