One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: An uncertain balance between risks and benefits
We sought to assess postoperative outcome after pneumonectomy after neoadjuvant therapy in patients with non-small cell lung cancer. This retrospective study included 100 patients treated from January 1989 through December 2003 for a primary lung cancer in whom pneumonectomy had been performed after...
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description | We sought to assess postoperative outcome after pneumonectomy after neoadjuvant therapy in patients with non-small cell lung cancer.
This retrospective study included 100 patients treated from January 1989 through December 2003 for a primary lung cancer in whom pneumonectomy had been performed after an induction treatment. Surgical intervention had not been considered initially for the following reasons: N2 disease (stage IIIA, n = 79), doubtful resectability (stage IIIB [T4, N0], n = 19), and M1 disease (stage IV [T2, N0, M1, solitary brain metastasis], n = 2). All patients received a 2-drug platinum-based regimen with a median of 2.5 cycles (range, 2–4 cycles), and 30 had associated radiotherapy (30–45 Gy).
There were 55 right and 45 left resections. Overall 30-day and 90-day mortality rates were 12% and 21%, respectively. At multivariate analysis, one inde- pendent prognostic factor entered the model to predict 30-day mortality: postoperative cardiovascular event (relative risk, 45.7; 95% confidence interval, 3.7–226.7;
P = .001). Four variables predicted 90-day mortality: age of more than 60 years (relative risk, 5.06; 95% confidence interval, 1.47–17.48;
P = .01), male sex (relative risk, 8.25; 95% confidence interval, 1.01–67.34;
P = .049), postoperative respiratory event (relative risk, 3.64; 95% confidence interval, 1.14–9.37;
P = .007), and postoperative cardiovascular event (relative risk, 7.84; 95% confidence interval, 3.12–19.71;
P < .001). Estimated overall survivals in 90-day survivors were 35% (range, 29%-41%) and 25% (range, 19.3%-30.7%) at 3 and 5 years, respectively. At multivariate analysis, one independent prognostic factor entered the model: pathologic stage III-IV residual disease (relative risk, 1.89; 95% confidence interval, 1.09–3.26;
P = .022).
Pneumonectomy after induction therapy is a high-risk procedure, the survival benefit of which appears uncertain. |
doi_str_mv | 10.1016/j.jtcvs.2004.11.022 |
format | Article |
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This retrospective study included 100 patients treated from January 1989 through December 2003 for a primary lung cancer in whom pneumonectomy had been performed after an induction treatment. Surgical intervention had not been considered initially for the following reasons: N2 disease (stage IIIA, n = 79), doubtful resectability (stage IIIB [T4, N0], n = 19), and M1 disease (stage IV [T2, N0, M1, solitary brain metastasis], n = 2). All patients received a 2-drug platinum-based regimen with a median of 2.5 cycles (range, 2–4 cycles), and 30 had associated radiotherapy (30–45 Gy).
There were 55 right and 45 left resections. Overall 30-day and 90-day mortality rates were 12% and 21%, respectively. At multivariate analysis, one inde- pendent prognostic factor entered the model to predict 30-day mortality: postoperative cardiovascular event (relative risk, 45.7; 95% confidence interval, 3.7–226.7;
P = .001). Four variables predicted 90-day mortality: age of more than 60 years (relative risk, 5.06; 95% confidence interval, 1.47–17.48;
P = .01), male sex (relative risk, 8.25; 95% confidence interval, 1.01–67.34;
P = .049), postoperative respiratory event (relative risk, 3.64; 95% confidence interval, 1.14–9.37;
P = .007), and postoperative cardiovascular event (relative risk, 7.84; 95% confidence interval, 3.12–19.71;
P < .001). Estimated overall survivals in 90-day survivors were 35% (range, 29%-41%) and 25% (range, 19.3%-30.7%) at 3 and 5 years, respectively. At multivariate analysis, one independent prognostic factor entered the model: pathologic stage III-IV residual disease (relative risk, 1.89; 95% confidence interval, 1.09–3.26;
P = .022).
Pneumonectomy after induction therapy is a high-risk procedure, the survival benefit of which appears uncertain.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2004.11.022</identifier><identifier>PMID: 16077407</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>Philadelphia, PA: Mosby, Inc</publisher><subject>Adult ; Aged ; Antineoplastic Agents - administration & dosage ; Biological and medical sciences ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - pathology ; Carcinoma, Non-Small-Cell Lung - therapy ; Combined Modality Therapy ; Female ; Humans ; Lung Neoplasms - mortality ; Lung Neoplasms - pathology ; Lung Neoplasms - therapy ; Male ; Medical sciences ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Platinum Compounds - administration & dosage ; Pneumology ; Pneumonectomy ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Analysis ; Treatment Outcome ; Tumors of the respiratory system and mediastinum</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2005-08, Vol.130 (2), p.416-425</ispartof><rights>2005 The American Association for Thoracic Surgery</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4452-519dca5acb32d39361103fcbe14d9e96f6358c1c53d8c7c30859a91d370135d53</citedby><cites>FETCH-LOGICAL-c4452-519dca5acb32d39361103fcbe14d9e96f6358c1c53d8c7c30859a91d370135d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2004.11.022$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17147499$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16077407$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Doddoli, Christophe</creatorcontrib><creatorcontrib>Barlesi, Fabrice</creatorcontrib><creatorcontrib>Trousse, Delphine</creatorcontrib><creatorcontrib>Robitail, Stéphane</creatorcontrib><creatorcontrib>Yena, Sadio</creatorcontrib><creatorcontrib>Astoul, Philippe</creatorcontrib><creatorcontrib>Giudicelli, Roger</creatorcontrib><creatorcontrib>Fuentes, Pierre</creatorcontrib><creatorcontrib>Thomas, Pascal</creatorcontrib><title>One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: An uncertain balance between risks and benefits</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>We sought to assess postoperative outcome after pneumonectomy after neoadjuvant therapy in patients with non-small cell lung cancer.
This retrospective study included 100 patients treated from January 1989 through December 2003 for a primary lung cancer in whom pneumonectomy had been performed after an induction treatment. Surgical intervention had not been considered initially for the following reasons: N2 disease (stage IIIA, n = 79), doubtful resectability (stage IIIB [T4, N0], n = 19), and M1 disease (stage IV [T2, N0, M1, solitary brain metastasis], n = 2). All patients received a 2-drug platinum-based regimen with a median of 2.5 cycles (range, 2–4 cycles), and 30 had associated radiotherapy (30–45 Gy).
There were 55 right and 45 left resections. Overall 30-day and 90-day mortality rates were 12% and 21%, respectively. At multivariate analysis, one inde- pendent prognostic factor entered the model to predict 30-day mortality: postoperative cardiovascular event (relative risk, 45.7; 95% confidence interval, 3.7–226.7;
P = .001). Four variables predicted 90-day mortality: age of more than 60 years (relative risk, 5.06; 95% confidence interval, 1.47–17.48;
P = .01), male sex (relative risk, 8.25; 95% confidence interval, 1.01–67.34;
P = .049), postoperative respiratory event (relative risk, 3.64; 95% confidence interval, 1.14–9.37;
P = .007), and postoperative cardiovascular event (relative risk, 7.84; 95% confidence interval, 3.12–19.71;
P < .001). Estimated overall survivals in 90-day survivors were 35% (range, 29%-41%) and 25% (range, 19.3%-30.7%) at 3 and 5 years, respectively. At multivariate analysis, one independent prognostic factor entered the model: pathologic stage III-IV residual disease (relative risk, 1.89; 95% confidence interval, 1.09–3.26;
P = .022).
Pneumonectomy after induction therapy is a high-risk procedure, the survival benefit of which appears uncertain.</description><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Carcinoma, Non-Small-Cell Lung - therapy</subject><subject>Combined Modality Therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Platinum Compounds - administration & dosage</subject><subject>Pneumology</subject><subject>Pneumonectomy</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Tumors of the respiratory system and mediastinum</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQxi0EotvCEyAhX4BTgifOPyNxqCoKSJV6AYmb5diTrpfEXmxnqz4Fr4zTXak3Lrb16TffjL8h5A2wEhi0H3flLulDLCvG6hKgZFX1jGyAia5o--bXc7JhWSqaquJn5DzGHWOsYyBekjNoWdfVrNuQv7cO6XZxJqCh2ruIekn2gHTvcJm9Q538bDFSNSYM1Dqz6GS9o2mLQe0f6OgDdd4VcVbTRDXmY1rcHdXKaQyf6KWjy_pKyjo6qGmV6YDpHtHRYOPvbO1MVhyONsVX5MWopoivT_cF-Xn95cfVt-Lm9uv3q8ubQtd1kz8FwmjVKD3wynDBWwDGRz0g1EagaMeWN70G3XDT605z1jdCCTA8B8Ab0_AL8v7ouw_-z4IxydnGdXrl0C9Rtn1d10JABvkR1MHHGHCU-2BnFR4kMLnuQe7k4x7kugcJIHPouertyX4ZZjRPNafgM_DuBKio1TSGnIuNT1wHdZf7Z-7Dkdvau-29DSgfg862sLaNwJmsZA1tJj8fScyxHSwGGbXFnLbJVTpJ4-1_R_4HC9S3fw</recordid><startdate>200508</startdate><enddate>200508</enddate><creator>Doddoli, Christophe</creator><creator>Barlesi, Fabrice</creator><creator>Trousse, Delphine</creator><creator>Robitail, Stéphane</creator><creator>Yena, Sadio</creator><creator>Astoul, Philippe</creator><creator>Giudicelli, Roger</creator><creator>Fuentes, Pierre</creator><creator>Thomas, Pascal</creator><general>Mosby, Inc</general><general>AATS/WTSA</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200508</creationdate><title>One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: An uncertain balance between risks and benefits</title><author>Doddoli, Christophe ; Barlesi, Fabrice ; Trousse, Delphine ; Robitail, Stéphane ; Yena, Sadio ; Astoul, Philippe ; Giudicelli, Roger ; Fuentes, Pierre ; Thomas, Pascal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4452-519dca5acb32d39361103fcbe14d9e96f6358c1c53d8c7c30859a91d370135d53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Carcinoma, Non-Small-Cell Lung - mortality</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>Carcinoma, Non-Small-Cell Lung - therapy</topic><topic>Combined Modality Therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Platinum Compounds - administration & dosage</topic><topic>Pneumology</topic><topic>Pneumonectomy</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Tumors of the respiratory system and mediastinum</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Doddoli, Christophe</creatorcontrib><creatorcontrib>Barlesi, Fabrice</creatorcontrib><creatorcontrib>Trousse, Delphine</creatorcontrib><creatorcontrib>Robitail, Stéphane</creatorcontrib><creatorcontrib>Yena, Sadio</creatorcontrib><creatorcontrib>Astoul, Philippe</creatorcontrib><creatorcontrib>Giudicelli, Roger</creatorcontrib><creatorcontrib>Fuentes, Pierre</creatorcontrib><creatorcontrib>Thomas, Pascal</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Doddoli, Christophe</au><au>Barlesi, Fabrice</au><au>Trousse, Delphine</au><au>Robitail, Stéphane</au><au>Yena, Sadio</au><au>Astoul, Philippe</au><au>Giudicelli, Roger</au><au>Fuentes, Pierre</au><au>Thomas, Pascal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: An uncertain balance between risks and benefits</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2005-08</date><risdate>2005</risdate><volume>130</volume><issue>2</issue><spage>416</spage><epage>425</epage><pages>416-425</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>We sought to assess postoperative outcome after pneumonectomy after neoadjuvant therapy in patients with non-small cell lung cancer.
This retrospective study included 100 patients treated from January 1989 through December 2003 for a primary lung cancer in whom pneumonectomy had been performed after an induction treatment. Surgical intervention had not been considered initially for the following reasons: N2 disease (stage IIIA, n = 79), doubtful resectability (stage IIIB [T4, N0], n = 19), and M1 disease (stage IV [T2, N0, M1, solitary brain metastasis], n = 2). All patients received a 2-drug platinum-based regimen with a median of 2.5 cycles (range, 2–4 cycles), and 30 had associated radiotherapy (30–45 Gy).
There were 55 right and 45 left resections. Overall 30-day and 90-day mortality rates were 12% and 21%, respectively. At multivariate analysis, one inde- pendent prognostic factor entered the model to predict 30-day mortality: postoperative cardiovascular event (relative risk, 45.7; 95% confidence interval, 3.7–226.7;
P = .001). Four variables predicted 90-day mortality: age of more than 60 years (relative risk, 5.06; 95% confidence interval, 1.47–17.48;
P = .01), male sex (relative risk, 8.25; 95% confidence interval, 1.01–67.34;
P = .049), postoperative respiratory event (relative risk, 3.64; 95% confidence interval, 1.14–9.37;
P = .007), and postoperative cardiovascular event (relative risk, 7.84; 95% confidence interval, 3.12–19.71;
P < .001). Estimated overall survivals in 90-day survivors were 35% (range, 29%-41%) and 25% (range, 19.3%-30.7%) at 3 and 5 years, respectively. At multivariate analysis, one independent prognostic factor entered the model: pathologic stage III-IV residual disease (relative risk, 1.89; 95% confidence interval, 1.09–3.26;
P = .022).
Pneumonectomy after induction therapy is a high-risk procedure, the survival benefit of which appears uncertain.</abstract><cop>Philadelphia, PA</cop><pub>Mosby, Inc</pub><pmid>16077407</pmid><doi>10.1016/j.jtcvs.2004.11.022</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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source | MEDLINE; ScienceDirect Journals (5 years ago - present); EZB-FREE-00999 freely available EZB journals |
subjects | Adult Aged Antineoplastic Agents - administration & dosage Biological and medical sciences Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - therapy Combined Modality Therapy Female Humans Lung Neoplasms - mortality Lung Neoplasms - pathology Lung Neoplasms - therapy Male Medical sciences Middle Aged Neoadjuvant Therapy Neoplasm Staging Platinum Compounds - administration & dosage Pneumology Pneumonectomy Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Analysis Treatment Outcome Tumors of the respiratory system and mediastinum |
title | One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: An uncertain balance between risks and benefits |
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