ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Long-term survival results of non-small cell lung cancer patients with complete pathological response after neoadjuvant therapy
Soner Gürsoy 1, Ozan Usluer 1, Ahmet Üçvet 1, Ahmet Emin Erbaycu2, Şeyda Örs Kaya 1, Hakan Koparal3
1Departments of Thoracic Surgery, Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
2Departments of Chest Diseases, Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
3Departments of Nuclear Medicine, Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
DOI : 10.5606/tgkdc.dergisi.2016.11927
Background: This study aims to evaluate survival and recurrence rates in pT0/T1N0/M0 non-small cell lung cancer patients who underwent surgical resection after chemotherapy and/or radiotherapy, and investigate the role of positron emission tomography/computed tomography in preoperative evaluation.

Methods: A total of 54 patients (52 males, 2 females; mean age 59.2±9.3 years; range 42 to 77 years) with locally advanced non-small cell lung cancer without lymph node metastasis who had induction therapy and were proven to be pT0N0 ( n=25) a nd pT1N0 (n=29) after pulmonary resection were included in the study. Patients were evaluated with thoracic computed tomography, bronchoscopy, respiratory function tests, and 18 patients with positron emission tomography/computed tomography, additionally. Those considered to be unresectable were clinically staged according to radiological findings. Invasive staging methods including transbronchial needle aspiration biopsy, mediastinoscopy, and video-assisted thoracoscopic surgery were performed for histological confirmation in those with resectable disease and N2 findings.

Results: Mean follow-up duration was 34.8 months. Mean survival duration and five-year survival rates were 90.8 months and 86.3% in T0 patients and 62.6 months and 53.7% in T1 patients, respectively. Recurrence rates were significantly lower in T0 patients (p=0.03). Sensitivity, specificity, positive predictive value, and negative predictive value of preoperative positron emission tomography/computed tomography were 78%, 56%, 64%, and 71%, respectively. Negative predictive value in T0 and positive predictive value in T1 patients was 100%. Accuracy values in T0 and T1 patients (56% and 78%, respectively) were similar (p=0.3).

Conclusion: Survival rates in pT0 and pT1 non-small cell lung cancer patients, who underwent lung resection after chemotherapy and/or radiotherapy, were similar with those of early stage patients who underwent surgery without induction therapy. Accuracy value of positron emission tomography/computed tomography in determining the presence of viable tumor cells was lower than expected.

Keywords : Chemotherapy, lung cancer surgery, positron emission tomography
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