Comparative effectiveness of neoadjuvant chemoradiotherapy versus chemotherapy alone followed by surgery for patients with stage IIIA non-small cell lung cancer.

摘要: Abstract Objectives The optimal neoadjuvant therapy prior to surgical resection of stage IIIA non-small cell lung cancer (NSCLC) is controversial, as data support both preoperative chemoradiotherapy (N-CRT) and chemotherapy (N-CTX). We evaluated the comparative effectiveness N-CRT versus N-CTX in patients National Cancer Database (NCDB). Methods Patients NCDB with NSCLC treated or surgery between 2003 2005 were analyzed. Outcomes included overall survival (OS), residual nodal disease (RND), any adverse pathologic features (APF=RND positive margins), 30-day postoperative mortality (POPM). impact post-operative radiotherapy (PORT) after was also investigated. Results cohort consisted 1076 patients: 700 (65%) underwent N-CRT. 5-year OS for entire 39% (39.2% vs. 38.6% N-CTX, p =NS). On multivariable regression, there no difference ( =0.70). However, associated a lower independent risk RND (odds ratio, OR, 0.75, =0.02) APF (OR 0.67, =0.0023). Among patients, PORT inferior without (hazard ratio 1.68, =0.01) but not APF. did increase early POPM, readmission rates, length stay. Conclusion There these two strategies, although improved outcomes. These either treatment approach, consultation critical ensure operability. indications factors require further investigation.