Journal of Surgical Oncology 46: 15-20 (1991)
Postoperative Adjuvant Chemotherapy in Non-Small Cell lung Cancer: Prognostic Value of DNA Ploidy and Postrecurrent Survival YUKITO ICHINOSE, MD, NOBUYUKI HARA, MD, MITSUO OHTA, MD, AKIRA MOTOHIRO, TOMOHARU KUDA, MD, AND HlROSHl ASO, MD From the Department of Chest Surgery, National Kyushu Cancer Center, Minami-ku, Fukuoka, lapan
MD,
Eighty-six patients with non-small cell lung cancer who underwent curative operations were postoperatively randomized to control and adjuvant chemotherapy groups. In the adjuvant chemotherapy group, patients received cisplatin-based combination chemotherapy 3 or 4 weeks after operation and the average cycle of chemotherapy was 2.3 (from 1 to 6 cycles). In this trial, no evidence of improved survival or delayed recurrence was seen in the treated patients. In multivariate analysis of prognostic variables, the most important factor was the pathological stage of the disease and, second, DNA ploidy of the primary tumor. Although histology (squamous vs. non-squamous cell carcinoma) had a trend to influence the survival, it was not a significant factor. A total of 33 patients had recurrences: 17 and 16 patients were in control and adjuvant chemotherapy groups , respectively. Postrecurrent survival in the adjuvant chemotherapy group was significantly shorter than that in the control group, as determined by the generalized Wilcoxon and log rank tests. Median survival time after recurrence in the control and adjuvant therapy groups was 18.5 and 7.5 months, respectively. These results suggest that DNA ploidy of primary tumors should be considered as a prognostic factor in future trials of adjuvant therapy. Furthermore, analysis of postrecurrent survival in the adjuvant chemotherapy trial, as well as that of overall and disease-free survivals should be done. KEYWORDS:primary tumor, cisplatin, prognosis
In 75% of patients with resected non-small cell lung cancer, the first recurrence is systemic [l]. This fact To conduct a clinical trial, it is necessary to randomize or stratify for important prognostic factors. The most indicates that adjuvant chemotherapy is necessary to important factor in resected non-small cell lung cancer is improve the survival rate of patients undergoing operathe pathological stage of the disease [1,2]. Recently, tion. Up to now, many studies have been performed DNA ploidy of resected non-small cell lung cancer has evaluating adjuvant chemotherapy in non-small cell lung been studied to determine whether it is a prognostic cancer. However, by and large, the results of these factor. Several reports have shown that DNA ploidy of studies have been disappointing [I]. Some trials evaluthe tumor is an independent prognostic factor [3,4]. ating adjuvant chemotherapy have shown that survival in However, to our knowledge, there is no report proving patients receiving adjuvant chemotherapy has been somethe importance of DNA ploidy as a prognostic factor in Accepted for publication September 25, 1990. randomized clinical trials for treatment of resected non- Address reprint requests to Dr. Yukito Ichinose, Dept. of Chest small cell lung cancer, such as surgical adjuvant chemo- Surgery, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 815, Japan. therapy.
INTRODUCTION
0 1991 Wiley-Liss, Inc.
16
Ichinose et al. TABLE I. Distribution of Patient Characteristics Control Stage I I1 IIIA (111-112) Histology Squamous cell ca.d Non-squamous cell ca.a DNA ploidy Diploid Aneuploid Unknown Extent of operation Lobectomy Pneumonectomy Age
Postoperative Adjuvant Chemotherapy in Non-Small Cell lung Cancer: Prognostic Value of DNA Ploidy and Postrecurrent Survival YUKITO ICHINOSE, MD, NOBUYUKI HARA, MD, MITSUO OHTA, MD, AKIRA MOTOHIRO, TOMOHARU KUDA, MD, AND HlROSHl ASO, MD From the Department of Chest Surgery, National Kyushu Cancer Center, Minami-ku, Fukuoka, lapan
MD,
Eighty-six patients with non-small cell lung cancer who underwent curative operations were postoperatively randomized to control and adjuvant chemotherapy groups. In the adjuvant chemotherapy group, patients received cisplatin-based combination chemotherapy 3 or 4 weeks after operation and the average cycle of chemotherapy was 2.3 (from 1 to 6 cycles). In this trial, no evidence of improved survival or delayed recurrence was seen in the treated patients. In multivariate analysis of prognostic variables, the most important factor was the pathological stage of the disease and, second, DNA ploidy of the primary tumor. Although histology (squamous vs. non-squamous cell carcinoma) had a trend to influence the survival, it was not a significant factor. A total of 33 patients had recurrences: 17 and 16 patients were in control and adjuvant chemotherapy groups , respectively. Postrecurrent survival in the adjuvant chemotherapy group was significantly shorter than that in the control group, as determined by the generalized Wilcoxon and log rank tests. Median survival time after recurrence in the control and adjuvant therapy groups was 18.5 and 7.5 months, respectively. These results suggest that DNA ploidy of primary tumors should be considered as a prognostic factor in future trials of adjuvant therapy. Furthermore, analysis of postrecurrent survival in the adjuvant chemotherapy trial, as well as that of overall and disease-free survivals should be done. KEYWORDS:primary tumor, cisplatin, prognosis
In 75% of patients with resected non-small cell lung cancer, the first recurrence is systemic [l]. This fact To conduct a clinical trial, it is necessary to randomize or stratify for important prognostic factors. The most indicates that adjuvant chemotherapy is necessary to important factor in resected non-small cell lung cancer is improve the survival rate of patients undergoing operathe pathological stage of the disease [1,2]. Recently, tion. Up to now, many studies have been performed DNA ploidy of resected non-small cell lung cancer has evaluating adjuvant chemotherapy in non-small cell lung been studied to determine whether it is a prognostic cancer. However, by and large, the results of these factor. Several reports have shown that DNA ploidy of studies have been disappointing [I]. Some trials evaluthe tumor is an independent prognostic factor [3,4]. ating adjuvant chemotherapy have shown that survival in However, to our knowledge, there is no report proving patients receiving adjuvant chemotherapy has been somethe importance of DNA ploidy as a prognostic factor in Accepted for publication September 25, 1990. randomized clinical trials for treatment of resected non- Address reprint requests to Dr. Yukito Ichinose, Dept. of Chest small cell lung cancer, such as surgical adjuvant chemo- Surgery, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 815, Japan. therapy.
INTRODUCTION
0 1991 Wiley-Liss, Inc.
16
Ichinose et al. TABLE I. Distribution of Patient Characteristics Control Stage I I1 IIIA (111-112) Histology Squamous cell ca.d Non-squamous cell ca.a DNA ploidy Diploid Aneuploid Unknown Extent of operation Lobectomy Pneumonectomy Age
