Dataset Information

Outcomes after neoadjuvant or adjuvant chemotherapy for cT2-4N0-1 non-small cell lung cancer: A propensity-matched analysis.

ABSTRACT: OBJECTIVE:Comparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non-small cell lung cancer has not been extensively studied. METHODS:Patients with cT2-4N0-1M0 non-small cell lung cancer who received platinum-based chemotherapy were retrospectively identified. Exclusion criteria included stage IV disease, induction radiotherapy, and targeted therapy. The primary end point was disease-free survival. Secondary end points were overall survival, chemotherapy tolerance, and ability of Response Evaluation Criteria In Solid Tumors response to predict survival. Survival was estimated using the Kaplan-Meier method, compared using the log-rank test and Cox proportional hazards models, and stratified using matched pairs after propensity score matching. RESULTS:In total, 330 patients met the inclusion criteria (n = 92/group after propensity-score matching; median follow-up, 42 months). Five-year disease-free survival was 49% (95% confidence interval, 39-61) for neoadjuvant chemotherapy versus 48% (95% confidence interval, 38-61) for adjuvant chemotherapy (P = .70). On multivariable analysis, disease-free survival was not associated with neoadjuvant chemotherapy or adjuvant chemotherapy (hazard ratio, 1.1; 95% confidence interval, 0.64-1.90; P = .737), nor was overall survival (hazard ratio, 1.21; 95% confidence interval, 0.63-2.30; P = .572). The neoadjuvant chemotherapy group was more likely to receive full doses and cycles of chemotherapy (P = .014/0.005) and had fewer grade 3 or greater toxicities (P = .001). Response Evaluation Criteria In Solid Tumors response to neoadjuvant chemotherapy was associated with disease-free survival (P = .035); 15% of patients receiving neoadjuvant chemotherapy (14/92) had a major pathologic response. CONCLUSIONS:Timing of chemotherapy, before or after surgery, is not associated with an improvement in overall or disease-free survival among patients with cT2-4N0-1M0 non-small cell lung cancer who undergo complete surgical resection.

SUBMITTER: Brandt WS

PROVIDER: S-EPMC6344258 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Outcomes after neoadjuvant or adjuvant chemotherapy for cT2-4N0-1 non-small cell lung cancer: A propensity-matched analysis.

Brandt Whitney S WS Yan Wanpu W Zhou Jian J Tan Kay See KS Montecalvo Joseph J Park Bernard J BJ Adusumilli Prasad S PS Huang James J Bott Matthew J MJ Rusch Valerie W VW Molena Daniela D Travis William D WD Kris Mark G MG Chaft Jamie E JE Jones David R DR

The Journal of thoracic and cardiovascular surgery 20181010 2

<h4>Objective</h4>Comparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non-small cell lung cancer has not been extensively studied.<h4>Methods</h4>Patients with cT2-4N0-1M0 non-small cell lung cancer who received platinum-based chemotherapy were retrospectively identified. Exclusion criteria included stage IV disease, induction radiotherapy, and targeted therapy. The primary end point was disease-free survival. Secondary end points were ov ...[more]

PMID: 30415902

Similar Datasets

Project description:BackgroundTo estimate the efficacy of neoadjuvant chemotherapy (NCT) in stage T3-4N1 nasopharyngeal carcinoma (NPC).MethodsData on stage T3-4N1 NPC patients treated with concurrent chemoradiotherapy (CCRT) with or without NCT at the Sun Yat-sen University Cancer Center between January 2006 and December 2013 were retrospectively reviewed. Propensity score matching (PSM) was carried out to balance prognostic factors in NCT followed by CCRT (NCT + CCRT) group and CCRT group in a 1:1 ratio. Survival outcomes of matched patients in the two groups were compared, and prognostic factors were identified using Cox regression model.ResultsA total of 282 patients were involved in this study, with 136 of NCT + CCRT group and 146 of CCRT group. After PSM, 85 pairs of patients were selected. There were no significant differences in 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and recurrence-free survival (RFS) between NCT + CCRT group and CCRT group (81.0% vs. 77.5%, P = 0.750; 85.8% vs. 88.1%, P = 0.495; 92.5% vs. 93.9%, P = 0.759; 81.0% vs.77.5%, P = 0.919, respectively). Multivariate analysis found that smoking history (P = 0.044) and T classification (P = 0.027) were independent prognostic factors for OS, lymph node diameter (P = 0.032) was independent prognostic factor for LRFS, positive pretreatment lymph node condition (PLNC), which was defined as the lymph node necrosis or confluent, was independent prognostic factor for DRFS (P = 0.007), and RFS (P = 0.009). Lower 5-year OS (82.7% vs. 94.1%, P = 0.014), DRFS (79.3% vs. 96.2%, P = 0.003), and RFS (62.4% vs. 86.8%, P = 0.001) were found in positive PLNC group compared with negative PLNC group. In terms of toxicities, the incidences of acute hematological Grade 3-4 adverse events (AEs) were higher in NCT + CCRT group compared with CCRT group (P < 0.05), while no significant difference was observed in the rates of non-hematological Grade 3-4 AEs between these two groups (P > 0.05).ConclusionsAdditional NCT is not associated with improved survival outcomes for patients with stage T3-4N1 NPC, but bring increased hematological Grade 3-4 AEs. PLNC is independent prognostic factor in stage T3-4N1 NPC, with positive PLNC correlating with poor survival outcomes.

Project description:Background The optimal treatment for pulmonary metastases has not been determined, and the survival benefit of surgical resection in selected patients remains controversial. The purpose of this retrospective study was to explore whether surgery can prolong survival in patients with pulmonary metastases compared with chemotherapy, and to analyze the factors that may affect the long-term survival of patients with pulmonary metastases. Methods We retrospectively analyzed the medical records of patients with pulmonary metastases from June 2012 to June 2019. Propensity score matching (PSM) was used to balance factors that might affect survival between the two groups. The data were analyzed by Kaplan-Meier survival analysis and Cox proportional hazards models to compare the survival of the surgery group and the chemotherapy group. Results A total of 202 patients with pulmonary metastases were enrolled in the study, with 43 patients in the surgery group and 43 in the chemotherapy group after screening and PSM. After PSM, patients in the surgery group had better survival than those in the chemotherapy group, with 5-year overall survival (OS) rates of 75.1% and 48.0%, respectively (P=0.017). Univariate analysis of the two groups of patients found that the treatment method, the number of metastases, and the total diameter of metastases were prognostic factors, but multivariate analysis did not find independent prognostic factors. In the surgical group, univariate analysis found that disease-free interval (DFI), the number of metastases, surgical methods, resection scope and surgical route were prognostic factors, and multivariate analysis showed that only DFI was an independent prognostic factor. In the chemotherapy group, DFI and the response of metastases to chemotherapy were found to be prognostic factors in univariate analysis, but no independent prognostic factors were found in multivariate analysis. Conclusions Surgery does not provide a significant survival advantage. For patients undergoing surgery, longer DFI predicts better survival.

Dataset Information

Outcomes after neoadjuvant or adjuvant chemotherapy for cT2-4N0-1 non-small cell lung cancer: A propensity-matched analysis.

Publications

Outcomes after neoadjuvant or adjuvant chemotherapy for cT2-4N0-1 non-small cell lung cancer: A propensity-matched analysis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets