Predictive factors for survival in stage IIIA N2 NSCLC patients treated with neoadjuvant CCRT followed by surgery

Purpose To assess the impact of imaging, surgical, histopathologic and patient-related factors on the risks of recurrence and overall survival (OS) in stage IIIA-N2 non-small cell lung cancer (NSCLC) patients undergoing definitive resection after neoadjuvant concurrent chemoradiotherapy (CCRT). Methods We retrospectively examined 104 consecutive patients with stage IIIA-N2 NSCLC who received neoadjuvant CCRT followed by surgery between 2008 and 2011. While reviewing the clinical and surgical data, we also assessed histopathologic and imaging (CT and PET/CT) factors. Disease-free survival (DFS) and OS were estimated with predictors for recurrence and survival. Results The 3-year OS for patients with and without recurrence was 37.1 and 63.3 %, respectively ( p < 0.001). Size decrease of target lesion(s) ≥36 % on post-neoadjuvant CCRT CT ( p = 0.048) and viable tumor size on surgical specimen <9.4 mm ( p = 0.035) were related to longer OS. Regarding shorter DFS, tumor size on post-neoadjuvant CCRT CT ( p = 0.046), SUV max of the primary tumor ( p = 0.011), male gender ( p = 0.023), total tumor size on surgical specimen ( p = 0.041) and viable tumor size on surgical specimen ( p = 0.043) were the significant predictors. Conclusions OS is prolonged with greater extent of size decrease of target lesion(s) on post-neoadjuvant CCRT CT and smaller viable tumor size on surgical specimen. Larger tumor size on post-neoadjuvant CCRT CT, higher SUV max , male gender, larger total tumor size and larger viable tumor size on surgical specimen may herald the higher probability of recurrence and the necessity of more attention.