Surgical resection for residual N₂ disease after induction chemotherapy

Background. Induction therapy is a common treatment modality for patients with stage IIIA non-small cell lung cancer (NSCLC). Although mediastinal nodal downstaging after induction therapy is generally considered a favorable prognostic feature, the benefit of resection in the presence of residual N ₂ disease is controversial. In this study we analyzed our experience with resection after induction chemotherapy in patients with residual N ₂ disease to more precisely define the role of surgical resection in this group of patients. Methods. In this retrospective analysis, we reviewed the records of 78 patients with N₂ disease who received induction therapy with preoperative intent between 1990 and 2003. All patients had potentially resectable disease. Survival analysis was performed using the Kaplan-Meier method. A Cox proportional hazards regression model was used to evaluate multiple prognostic factors. Results. There were 78 patients (39 men) with a median age of 64 years. Sixty had nonsquamous histology. Resection was performed in 52 patients (47 R₀). Hospital mortality was 1.9%. A complete pathologic response occurred in 2 of 52 (3.8%) patients and 19 of 52 (36%) patients had no residual N₂ disease. Overall 5-year survival for resected patients was 23%. Overall 5-year survival was 30% for N ₀-N₁ patients and 19% for those with residual N ₂ disease. Multivariable analysis identified clinical response to therapy (p = 0.0007) and histology (p = 0.01), but not residual N₂ disease (p = 0.65), as important prognostic variables. Conclusions. Surgical resection may be a viable option for patients with residual N₂ disease after induction chemotherapy, provided an R₀ resection can be performed.