SURGICAL TREATMENT OF PATIENTS WITH RESECTABLE NON SMALL CELL LUNG CANCER

Objective. Study based on long-term results of treatment of patients with resectable non-small cell lung cancer using surgical method specified prognostic factors.

Materials and methods. The analysis of surgical and multimodal treatment in 1420 patients with NSCLC. In 42.7% of patients metastases in the lymph nodes were absent in 28.1% revealed bronchopulmonary defeat and root nodes (N1), while 28.9% - mediastinal (N2). Radical surgery performed 92.8% of patients. Postoperative complications were diagnosed in 22.2%. The case fatality rate - 3.0%.

Results. The overall five-year survival of patients after radical treatment was 42,0 ± 1,6%, palliative - 19,8 ± 3,3%. When radical treatment for more than 5 years experienced a 65,0 ± 3,6% of patients with stage IA, 54,5 ± 3,4% - IB, 49,0 ± 5,2% - IIA, 40,8 ± 4,0% - IIB, 18,8 ± 2,5% - IIIA and 13,4 ± 5,8% - IIIB. In patients with N0 long-term results of treatment amounted to 58,4 ± 2,4%, were higher in squamous cell carcinoma (62,1 ± 3,5%), than adenocarcinoma (52,5 ± 4,6% p = 0.048) and largecancer (45,5 ± 7,7%, p = 0.008). Indicators of five-year survival after radical combined treatment in patients with N + were lower (30,9 ± 2,3%) and depended on the level of the lesion nodes (N1 or N2), interest areas of the mediastinum, the morphological structure of the tumor, as well as the volume of transactions.

Conclusions. Radical surgical and combined treatment (with postoperative radiotherapy) can be carried out by most of the patients with resectable non-small cell lung cancer with satisfactory long-term results. The main prognostic factors should be considered the type of the treatment, stage of disease, especially the state of regional hilar lymph nodes. Additional adverse prognostic factor in patients with N0 is adenogenous and macrocellular morphological type of cancer, at N1 - T4 tumors and macrocellular carcinoma, and N2 - Metastasis in some or all areas of the mediastinum and the volume of surgery - bilobectomy.

1. Pod red. Kaprina A.D., Starinskogo V.V., Petrovoj G.V. Sostojanie onkologicheskoj pomoshhi naseleniju Rossii v 2013 godu [Kniga]. - M : FGBU «MNIOI im. P.A. Gercena» Minzdrava Rossii, 2014. - str. 235.

2. Trahtenberg A.H., Kolbanov K. I. Rak legkogo [Book]. - M : Geotar Media, 2012. - p. 160.

3. Crino L., Weder W., van Meerbeeck J., Felip E. Klinicheskie rekomendacii ESMO po diagnostike, lecheniju i nabljudeniju pri nachal’nyh i mestnorasprostranennyh stadijah nemelkokletochnogo raka legkogo (NMRL).Minimal’nye klinicheskie rekomendacii evropejskogo obshhestva medicinskoj onkologii (ESMO) [Kniga] / perev. Perevod s angl. Moskva, RONC im N.N.Blohina. - M : RONC im N.N.Blohina, 2010.

4. Carretta A., Ciriaco P., Melloni G., Sayed I. Results of surgical treatment after neoadjuvant chemotherapy for stage III nonsmall cell lung cancer [Journal] // World J Surg. - 2008. - Vol. 32. - pp. 2636-42.

5. Scotti V., Meattini I., Saieva C. et al. Post-operative radiotherapy in N2 non-small cell lung cancer: a retrospective analysis of 175 patients [Journal] // Radiother Oncol. - 2010. - Vol. 96. - pp. 84-8.

6. Zhang X., Zhang B., Gao Y. Clinical application of adjuvant treatment after operation in patients with stage IIIa non-small cell lung cancer [Journal] // Zhongguo Fei Ai Za Zhi. - 2010. - Vol. 13. - pp. 357-62.

7. Matsuguma H., Oki I., Nakahara R. et al. Proposal of new nodal classifications for non-small-cell lung cancer bas 3d on the number and ratio of metastatic lymph nodes [Journal] // Eur J Cardiothorac Surg. - 2012. - Vol. 41. - pp. 19-24.

8. Volkov S.M. Ocenka jeffektivnosti i puti sovershenstvovanija hirurgii nemelkokletochnogo raka legkogo // Avtoref. dis. …... dok. med. nauk. - M : [b.n.], 2005 g. - str. 48.

9. Harchenko V.P., Hmelevskij E.V. Kombinirovannoe i hirurgicheskoe lechenie raka legkogo [Konferencija] // Materialy VI vserossijskogo s#ezda onkologov. - Rostov-na- Donu : [b.n.], 2005. - T. 1. - str. 345.

10. Van Rens M.T., de la Riviere A.B., Elbers H.R., van Den Bosch J.M. Prognostic assessment of 2,361 patients who underwent pulmonary resection for non-small cell lung cancer, stage I, II, and IIIA [Journal] // Chest. - 2000. - Vol. 117. - pp. 374–379.

11. Cerfolio R.J., Bryant A.S. Survival of patients with true pathologic stage I non-small cell lung cancer [Journal] // nn Thorac Surg. - 2009. - Vol. 88. - pp. 917-22.

12. Garcia-Yuste M., Matilla J.M., Duque J.L. et al. Surgical treatment of lung cancer: comparative assessment of the staging systems of 1986 and 1997. Results in 500 consecutive patients [Journal] // Arch Bronconeumol. - 2001. - Vol. 37. - p. 54.

13. Hayashi Y., Tomiyama I., Ishii H. et al. Prognostic assessment of the new UICC TNM classification for resected lung cancer [Journal] // Kyobu Geka. - 2000. - Vol. 53. - pp. 919-25.

14. Saito Y., Yamakawa Y., Kuriyama M. et al. Evaluation of new TNM lung cancer classification [Journal] // J Thorac Cardiovasc Surg. - 2000. - Vol. 48. - pp. 499–505.

15. Gonfiotti A., Crocetti E., Lopes Pegna A. et al. Prognostic variability in completely resected pN1 non-small-cell lung cancer [Journal] // Asian Cardiovasc Thorac Ann. - 2008. - Vol. 16. - pp. 375-80.

16. Caldarella A., Crocetti E., Comin C.E. et al. Prognostic variability among nonsmall cell lung cancer patients with pathologic N1 lymph node involvement. Epidemiological figures with strong clinical implication [Journal] // Cance. - 2006. - Vol. 107. - pp. 793-8.

17. Shimada Y., Tsuboi M., Saji H. et al. The prognostic impact of main bronchial lymph node involvement in non-small cell lung carcinoma: suggestions for a modification of the staging system [Journal] // Ann Thorac Surg. - 2009. - Vol. 88. - pp. 1583-8.

18. Okada M., Sakamoto T., Yuki T. et al. Border between N1 and N2 stations in lung carcinoma: lessons from lymph node metastatic patterns of lower lobe tumors [Journal] // J Thorac Cardiovasc Surg. - 2005. - Vol. 129. - p. 825.

19. Cerfolio R.J., Bryant A.S. Survival of patients with unsuspected N2 (stage IIIA) nonsmall-cell lung cancer [Journal] // Ann Thorac Surg. - 2008. - Vol. 86. - pp. 362-6; discussion 366-7.

20. 20. Ma Q., Liu D., Guo Y. et al. Surgical therapeutic strategy for non-small cell lung cancer with mediastinal lymph node metastasis (N2) [Journal] // Zhongguo Fei Ai Za Zhi. - 2010. - Vol. 13. - pp. 342-8.

21. Meacci E., Cesario A., Cusumano G. et al. Surgery for patients with persistent pathological N2 IIIA stage in non-small-cell lung cancer after induction radio-chemotherapy: the microscopic seed of doubt [Journal] // Eur J Cardiothorac Surg. - 2011. - Vol. 40. - pp. 656-63.

22. Tanaka F., Yanagihara K., Otake Y. et al. Prognostic factors in resected pathologic (p-) stage IIIA-N2, non-small-cell lung cancer [Journal] // Ann Surg Oncol. - 2004. - Vol. 11. - pp. 612-8.

23. Sakao Y., Miyamoto H., Yamazaki A. et al. Prognostic significance of metastasis to the highest mediastinal lymph node in nonsmall cell lung cancer [Journal] // Ann Thorac Sur. - 2006. - Vol. 81. - pp. 292-7.

24. Gawrychowski J., Gabriel A., Lackowska B. Heterogeneity of stage IIIA non-small cell lung cancers (NSCLC) and evaluation of late gesults of surgical treatment [Journal] // Eur J Surg Oncol. - 2003. - Vol. 29. - pp. 78-84.

25. Lally V.E., Zelterman D., Colasanto J.M. et al. Postoperative radiotherapy for stage II or III non-small-cell lung cancer using the Surveillance, Epidemiology, and End Results database [Journal] // J Clin Oncol. - 2006. - Vol. 24. - pp. 2998-3006.

26. Spoelstra F.O, Senan S, Le Pechoux C. et al. Lung Adjuvant Radiotherapy Trial Investigators Group. Variations in target volume definition for postoperative radiotherapy in stage III non-small-cell lung cancer: Analysis of an international contouring study [Journal] // Int J Radiat Oncol Biol Phys. - 2010. - Vol. 76. - pp. 1106—1113.

27. Le Chevalier T., Dunant A., Arriadada R. et al. Long-term results of the Internacional Adjuvant Lung Cancer Trial (IALT) evaluating adjuvant cisplatin-based chemotherapy in resected non-small cell cancer [Journal] // J Clin Oncol. - 2008. - Vol. 26. - p. 398 (abstr 7507).

28. Betticher D.C., Hsu Schmitz S.F., Tötsch M. et al. Prognostic factors affecting long-term outcomes in patients with resected stage IIIA pN2 non-small-cell lung cancer: 5-year follow-up of a phase II study [Journal] // Br J Cancer. - 2006. - Vol. 94. - pp. 1099-106.

29. Toyooka S., Kiura K., Shien K. et al. Induction chemoradiotherapy is superior to induction chemotherapy for the survival of nonsmall-cell lung cancer patients with pathological mediastinal lymph node metastasis [Journal] // Cardio Vase Thorac Surg. - 2012. - pp. 954-960.