Treatment Response and Survival Outcomes are Associated with Histologic Type in Non-small Cell Lung Cancer Treated with Trimodal Treatment

Tae Hee Hong¹, Hong Kwan Kim¹, Sumin Shin¹, Jong Ho Cho¹, Yong Soo Choi¹, Jae Ill Zo¹, Young Mog Shim¹, Keunchil Park², Myung-Ju Ahn², Jin Seok Ahn², Se-Hoon Lee², Jong-Mu Sun², Yong Chan Ahn³, Hong Ryull Pyo³, Jae Myoung Noh³, Joungho Han⁴, Jhingook Kim¹

¹Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., ²Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., ³Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., ⁴Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Purpose : Although biologic features might be different between adenocarcinoma(ADC) and squamous cell carcinoma(SqCC), histologic type has been rarely considered when selecting treatment strategy in non-small cell lung cancer with N2 disease. We investigated if histologic type is associated with treatment outcomes in patients undergoing trimodal treatment for N2 disease.

Methods : From 2003 to 2013, 374 patients underwent trimodal treatment for either ADC (n=233, 62.3%) or SqCC (n=141, 37.7%). A retrospective review was performed and clinicopathologic features and treatment outcomes were compared between ADC and SqCC.

Results : There were more male and smokers, more advanced clinical stages, and more bulky and/or multi-stationed N2 in SqCC than in ADC. Conversely, SqCC had earlier pathologic stages, more pathologic complete responders, and more frequent mediastinal downstaging than ADC. With a mean follow-up of 50.1 months, SqCC showed better 5-year recurrence-free survival(RFS) than ADC (ADC,22.8% vs. SqCC,43%; p=0.001). However, there was no difference in 5-year overall survival(OS) between the two groups (ADC,57.5% vs. SqCC,52.3%; p=0.366). This may be related to better (p<0.001) post-recurrence survival in ADC (mean,28 months) than in SqCC (mean,14.5 months). In ADC group, 164 patients developed recurrences and of those, 68 (41.5%) received targeted therapy. Patients who received targeted therapy showed better 5-year OS than those who did not (61% vs. 45.6%, p=0.025).

Conclusion : In this study, SqCC was associated with better treatment response and more favorable RFS than ADC. Despite poor RFS in ADC, its OS was improved by prolonged post-recurrence survival, which might be related to the use of targeted therapy for recurrence.

책임저자: Jhingook Kim

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

발표자: Tae Hee Hong, E-mail : taehee888@naver.com