Abstract 1245P
Background
The standard treatment for patients with clinical and pathological N2 (cN2pN2) lung cancer is chemoradiotherapy with or without surgery. Chemotherapy alone cannot cure such patients. However, radiation therapy is, in principle, contraindicated for lung cancer with interstitial pneumonia (IP). Thus, in clinical practice, surgery or best supportive care is usually performed for patients with cN2pN2 lung cancer with IP.
Methods
Among 2875 patients who underwent surgery for lung cancer between January 2009 and June 2018, 255 patients with cN2 lung cancer diagnosed based on computed tomography were retrospectively reviewed. Among them, 90 patients underwent lobectomy or more with mediastinal lymph node dissection and were proven to have pN2 disease. These 90 patients were divided into 2 groups: the cN2pN2 lung cancer without IP group (non-IP group) and the cN2pN2 lung cancer with IP group (IP group). We compared the clinicopathological features and surgical outcomes, including the 5-year overall survival (OS) rate, 5-year cancer specific survival (CSS) rate, and surgical morbidities.
Results
Fifty-four patients were classified into the non-IP group and twenty-six patients were classified into the IP group. The IP group had a significantly higher proportion of lung cancers originating from the lower lobe in comparison to the non-IP group (53.8% vs. 20.3%; p=0.004). The 5-year OS rate of the IP group was significantly lower than that of the non-IP group (21.8% vs. 41.2%; p=0.035). In the IP group, the 5-year OS and 5-year CSS rates of lung cancers originating from the lower lobe were higher in comparison to lung cancers originating from the upper or middle lobe (38.6% vs. 0%; p=0.07, 38.6% vs. 0%; p=0.017). In addition, in patients with lung cancer originating from the lower lobe, the 5-year OS (38.6% vs. 31.8%; p=0.713) and 5-year CSS (38.6% vs. 35.8%; p=0.917) rates did not differ between the IP and non-IP groups to a statistically significant extent.
Conclusions
Among patients with cN2pN2 lung cancer originating from the lower lobe, patients with IP had equivalent surgical outcomes to patients without IP. Thus, lobectomy with mediastinal lymph node dissection is a good indication for IP patients with cN2pN2 lung cancer originating from the lower lobe.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.