Pathologic Stage of Nonsmall Cell Lung Cancer Patients Presenting as Resectable Cases After Neoadjuvant Therapy Did Not Predict the Prognosis

According to the National Comprehensive Cancer Network (NCCN) guidelines, treatment plans for nonsmall cell lung cancer are to be based on cancer stage. Cancer staging for patients with resectable disease has been based on pathologic stage instead of preoperative clinical stage. However, the possibility of occult mediastinal lymph node metastases could lead to discrepancy between clinical and pathologic stage. While multi-modality treatments may be beneficial for patients with locally advanced disease, most studies have been based on clinical stage. The aim of this study was to identify the beneficial impact of neoadjuvant therapy and the prognostic value of final pathologic stage in these patients. This study enrolled 530 lung cancer patients who received anatomic resection and mediastinal lymph node dissection at Chang Gung Memorial Hospital from January 2005 through June 2011. All resected specimens were examined by pathologists. Postoperative adjuvant therapies were given according to NCCN guideline recommendations. The clinico-pathologic factors of these patients were collected and analyzed. Patients not receiving neoadjuvant therapy had a better probability of disease-free survival (P < 0.001) and overall survival (P = 0.0005), as well as a lower incidence of early relapse. Patients not receiving neoadjuvant therapy had a better disease-free survival rate in stages IA (P < 0.001), IB (P = 0.002), and IIB (P = 0.0117) from the point of view of final pathologic stage. Patients receiving neoadjuvant therapy may experience a higher incidence of early relapse. Neoadjuvant therapy did not show definite benefits in the disease-free and overall survival rates from the point of view of final pathologic stage. Pathologic stage of nonsmall cell lung cancer patients who presented with resectable disease after neoadjuvant therapy did not predict the prognosis.