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Long-Term Survival Associated With Complete Resection After Induction Chemotherapy in Stage IIIA (N2) and IIIB (T4N0-1) Non–Small-Cell Lung Cancer Patients: The Spanish Lung Cancer Group Trial 9901

Pilar Garrido, José Luis González-Larriba, Amelia Insa, Mariano Provencio, Antonio Torres, Dolores Isla, José Miguel Sanchez, Felipe Cardenal, Manuel Domine, Jose Ramon Barcelo, Vicente Tarrazona, Andres Varela, Rafael Aguilo, Julio Astudillo, Ignacio Muguruza, Angel Artal, Florentino Hernando-Trancho, Bartomeu Massuti, Maria Sanchez-Ronco, Rafael Rosell

From the Hospital Ramon y Cajal; Hospital San Carlos; Clinica Puerta de Hierro; Fundacion Jimenez Diaz; Autonomous University of Madrid, Madrid; Hospital Clinico, Valencia; Hospital Clinico; Hospital Miguel Servet, Zaragoza; Hospital Germans Trias i Pujol, Catalan Institute of Oncology, Badalona; Hospital Duran i Reynals, Catalan Institute of Oncology, Bellvitge; Hospital Cruces, Bilbao; and Hospital General, Alicante, Spain

Address reprint requests to Rafael Rosell, MD, Chief, Medical Oncology Service, Scientific Director of Oncology Research, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916 Badalona (Barcelona), Spain; e-mail: rrosell{at}ico.scs.es

Purpose: To assess the activity of induction chemotherapy followed by surgery in stage IIIA and selected stage IIIB non–small-cell lung cancer patients.

Patients and Methods: Mediastinoscopy proof of either positive N2 (IIIA) or T4N0-1 (IIIB) disease was required. Induction therapy was three cycles of cisplatin/gemcitabine/docetaxel, followed by surgery.

Results: From December 1999 to March 2003, 136 patients were entered onto the study; the clinical response rate in 129 assessable patients was 56%. The overall complete resection rate was 68.9% of patients eligible for surgery (72% of stage IIIA patients and 66% of stage IIIB patients) and 48% of all assessable patients. Eight (12.9%) of 62 completely resected patients had a pathologic complete response. Seven patients (7.8%) died during the postoperative period. The median overall survival time was 15.9 months, 3-year survival rate was 36.8%, and 5-year survival rate was 21.1%, with no significant differences in survival between stage IIIA and stage IIIB patients. Median survival time was 48.5 months for 62 completely resected patients, 12.9 months for 13 incompletely resected patients, and 16.8 months for 15 nonresected patients (P = .005). Three- and 5-year survival rates were 60.1% and 41.4% for completely resected patients, 23.1% and 11.5% for incompletely resected patients, and 31.1% and 0% for nonresected patients, respectively. In the multivariate analysis, complete resection (hazard ratio [HR] = 0.35; P < .0001), clinical response (HR = 0.32; P < .0001), and age younger than 60 years (HR = 0.64; P = .027) were the most powerful prognostic factors.

Conclusion: Induction chemotherapy followed by surgery is effective in stage IIIA and in selected stage IIIB patients attaining complete resection.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.