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The number of residual metastatic lymph nodes following neoadjuvant chemotherapy predicts survival in patients with stage III NSCLC.

Authors
 Se Hyun Kim  ;  Byoung Chul Cho  ;  Hye Jin Choi  ;  Kyung Young Chung  ;  Dae Joon Kim  ;  Moo-Suk Park  ;  Se Kyu Kim  ;  Joon Chang  ;  Sang-Joon Shin  ;  Joo Hyuk Sohn  ;  Joo Hang Kim 
Citation
 Lung Cancer, Vol.60(3) : 393-400, 2008 
Journal Title
 Lung Cancer 
ISSN
 0169-5002 
Issue Date
2008
MeSH
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage* ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Carcinoma, Non-Small-Cell Lung/blood ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Carcinoma, Non-Small-Cell Lung/pathology* ; Cisplatin/administration & dosage* ; Docetaxel ; Female ; Humans ; Lung Neoplasms/blood ; Lung Neoplasms/drug therapy* ; Lung Neoplasms/pathology* ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Neutropenia/chemically induced ; Paclitaxel/administration & dosage* ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Survival Analysis ; Taxoids/administration & dosage* ; Vinblastine/administration & dosage ; Vinblastine/analogs & derivatives* ; Vinorelbine
Keywords
Neoadjuvant chemotherapy ; Lymph node ; Prognostic ; Stage III ; NSCLC ; Downstaging ; Survival
Abstract
The prognosis of patients with stage III non-small-cell lung cancer (NSCLC) who achieve a pathological complete response or downstaging following neoadjuvant therapies are better than the prognosis of patients with residual metastatic lymph nodes (LN). However, the prognostic significance of the number of residual metastatic LNs remains unclear. From January 2001 to January 2006, 42 consecutive patients with stage IIIAN2 (22 patients) and IIIB without pleural effusion (20 patients) were treated with neoadjuvant chemotherapy. Thirty-four (81.0%) of the 42 patients were pathologically staged by mediastinoscopy. Neoadjuvant chemotherapy consisted of 3 cycles of platinum-based doublet (21 patients with gemcitabine, 15 with paclitaxel, and 6 with docetaxel). After neoadjuvant chemotherapy, a pathological complete response was achieved in one patient and downstaging was achieved in 24 patients. Pathological LN metastasis was absent in 9 patients (21.4%) and present in 33 patients (78.6%). With a median follow-up of 23 months, the 2-year disease-free survival (DFS) rate of patients without residual LN metastasis was statistically better than that of patients with residual LN metastasis (46% vs. 18% respectively, P=0.03). Among 33 patients with residual LN metastasis, age (P=0.01), pathological downstaging (P=0.098) and the number of residual metastatic LNs (median 14 months in 1-4 LN vs. median 5 months in LN > or =5; P=0.011) were significant predictors of DFS in univariate analysis. In multivariate analysis, the number of residual metastatic LNs was an independent predictor of DFS among patients with residual LN metastasis, irrespective of pathological downstaging. The number of residual metastatic lymph nodes following neoadjuvant chemotherapy is an independent predictor of DFS in patients with stage III NSCLC.
Full Text
http://www.sciencedirect.com/science/article/pii/S0169500207006691
DOI
10.1016/j.lungcan.2007.11.004
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Kim, Se Kyu(김세규)
Kim, Se Hyun(김세현)
Kim, Joo Hang(김주항)
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Sohn, Joo Hyuk(손주혁) ORCID logo https://orcid.org/0000-0002-2303-2764
Shin, Sang Joon(신상준) ORCID logo https://orcid.org/0000-0001-5350-7241
Chang, Joon(장준) ORCID logo https://orcid.org/0000-0003-4542-6841
Chung, Kyung Young(정경영)
Cho, Byoung Chul(조병철) ORCID logo https://orcid.org/0000-0002-5562-270X
Choi, Hye Jin(최혜진) ORCID logo https://orcid.org/0000-0001-5917-1400
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/108639
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