Subclassification of N2 Non–Small-Cell Lung Cancer
Authors: Frederic W. Grannis, F. Andre, T. Le Chevalier, D. Grunenwald
Journal: Journal of Clinical Oncology (2001)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2001.19.4.1228 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11181689 Subclassification of N2 Non–Small-Cell Lung Cancer Frederic W. Grannis JrxFrederic W. Grannis JrSearch for articles by this author F. AndrexF. AndreSearch for articles by this author , T. Le ChevalierxT. Le ChevalierSearch for articles by this author , D. GrunenwaldxD. GrunenwaldSearch for articles by this author Show More City of Hope National Medical Center, Duarte, CAInstitut Gustave Roussy, Villejuif, FranceInstitut Mutualiste Montsouris, Paris, France https://doi.org/10.1200/JCO.2001.19.4.1228 First Page Full Text PDF Figures and Tables © 2001 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse15022001In Reply:By asking about survival according to the mediastinal lymph node status and the extension of the tumor, Dr Grannis opens an important discussion about staging of stage III non–small-cell lung cancer (NSCLC) patients treated with neoadjuvant strategy.In our study, 5-year overall survival rates of patients with cN2L1 and cN2L2 who have been treated with preoperative chemotherapy were 20% and 14%, respectively (P = .07). Five-year overall survival rates of patients with T1/T2, T3, and T4 tumors were 19%, 14%, and 14%, respectively. Nevertheless, we remember that the primary goal of our study was to evaluate prognosis of stage IIIA N2 patients treated with surgery and not that of stage IIIB patients.1In our opinion, three major questions must be currently considered about staging of T4/N2 NSCLC. Is the mediastinal lymph node status a predictive marker for metastatic disease? Is the tumor extension predictive for metastatic or locoregional relapse? Is postinduction staging more accurate for evaluating patients?Pieces of answers can be found in clinical trials. Albain et al2 and Eberhardt et al3 have shown that postinduction mediastinal lymph node status is of prognostic importance. We confirmed these data in our phase II study including 40 patients with stage IIIB NSCLC treated with postinduction surgery (D. Grunenwald, manuscript submitted for publication). In addition, we clearly observed in this latter study that surgery per se is able to cure a significant rate of patients with T4 disease who exhibited persistent viable tumor cells in the primary tumor after induction chemoradiotherapy.Data currently available therefore suggest that clinical N2 status and L2 status are predictive for metastatic relapse and that T4 disease can be cured by surgery in selected cases. Although survival of these patients is similar, the goal of induction therapy is different: to eliminate micrometastasis for N2 and to allow a complete surgical resection in T4 patients. This consideration currently guides the planning of our protocols in stage III mN2L2/cN2/T4 patients.In our study, postoperative radiotherapy did not influence survival nor the incidence of locoregional relapse. Postoperative chemotherapy was performed in 5% of the patients, and data were insufficient to provide any conclusion.1 1. Andre F, Grunenwald D, Pignon J-P, et al: Survival of patients with resected N2 non–small-cell lung cancer: Evidence for a subclassification and implications. J Clin Oncol 18:: 2981,2000-2989, Link, Google Scholar2. Albain KS, Rush VW, Crowley JJ, et al: Concurrent cisplatin/etoposide plus chest radiotherapy followed by surgery for stage IIIAN2 and IIIB non small cell lung cancer: Mature results of Southwest Oncology Group phase II study 8805. J Clin Oncol 13:: 1880,1995-1892, Link, Google Scholar3. Eberhardt W, Wilke H, Stamatis G, et al: Preoperative chemotherapy followed by concurrent chemoradiation therapy based on hyperfractionated accelerated radiotherapy and definitive surgery in locally advanced non-small cell lung cancer: Mature results of a phase II trial. J Clin Oncol 16:: 662,1998-634, Google Scholar