Prognostic impact of bulky mediastinal lymph nodes (N2 > 2.5 cm) in patients with locally advanced non-small-cell lung cancer (LA-NSCLC) treated withplatinum-based induction chemotherapy

A group of 70 patients with locally advanced non-small-cell lung cancer (LA -NSCLC). treated in different phase II-III trials with platinum-based chemo therapy in two institutions, have been evaluated to identify potential base line prognostic factors predicting their survival. The eligibility criteria were patients with stage IIIA (N2)-IIIB, Eastern Cooperative Oncology Grou p performance status 0.1 and less than 5% weight loss. All 37 patients with stage IIIA(N2) were treated with platinum-based induction chemotherapy fol lowed by surgery plus radiotherapy if no progression was observed. The othe r 33 patients with stage IIIB were treated with platinum-based induction ch emotherapy followed by conventional fractionation radiotherapy if no progre ssion was observed. The overall response late to induction chemotherapy was 40%. Median survival of the 70 patients was 13 months, with a 4-year survi val of 15%. At univariate analysis, two prognostic factors correlated with survival: partial or complete response to induction chemotherapy (P < 0.000 01) and bulky mediastinal lymph nodes (N2 > 2.5 cm) (P = 0.03). At multivar iate analysis, only the response to induction chemotherapy retained statist ical significance (P = 0.00001). Randomized well-balanced prospective trial s considering initially mediastinal N2 node size are needed to clearly esta blish the role of chemotherapy. surgery and radiotherapy in LA-NSCLC. (C) 2 000 Elsevier Science Ireland Ltd. All rights reserved.