The evolution of treatment outcomes for resected stage IIIA non–small cell lung cancer over 16 years at a single institution

The effect of multimodality treatment including surgical intervention, chemotherapy, and radiation for potentially resectable stage IIIA non–small cell lung cancer in a practice setting remains to be defined. To determine which treatment factors are associated with improved survival, we evaluated outcomes for these patients at our institution over a 16-year period. We surveyed our institutional pathology database from 1986 through 2001 for patients with resected pathologic stage IIIA (N2) non–small cell lung cancer. Three hundred fifty-three patients were confirmed to have appropriate pathologic staging and attempted complete resection. These patients were assessed by means of univariate and multivariable analysis for factors associated with long-term survival. Stage migration was estimated by using a classification based on nodal station involvement. Median potential follow-up was 132 months. During the study period, 3- and 5-year survival increased; preoperative staging improved, relatively more lobectomies and fewer pneumonectomies were performed, and multimodality treatment was used more frequently. The number of positive N2 nodal stations did not change over time ( P = .14). Surgical intervention alone resulted in 3-year survival of 30%, and perioperative chemotherapy, radiation, or both increased 3-year survival to 38% ( P = .004). Multivariable analysis showed that male sex (hazard ratio, 1.44; 95% confidence interval, 1.13-1.84; P = .003), more than 2 positive mediastinal nodal stations (hazard ratio, 1.73; 95% confidence interval, 1.16-2.57; P = .007), R1 or R2 resection (hazard ratio, 1.72; 95% confidence interval, 1.22-2.41; P = .002), lower or middle lobe tumor location (hazard ratio, 1.63; 95% confidence interval, 1.28-2.08; P < .001), and surgical intervention alone (hazard ratio, 1.59; 95% confidence interval, 1.23-2.04; P < .001) were independent predictors of poor survival. The use of multimodality therapy appears to contribute to improved outcomes over time in patients with resected stage IIIA (N2) non–small cell lung cancer.