Outcomes of neoadjuvant and adjuvant chemotherapy in stage 2 and 3 non-small cell lung cancer: an analysis of the National Cancer Database

// Matthew MacLean 1 , Xin Luo 2 , Shidan Wang 1 , Kemp Kernstine 3 , David E. Gerber 4, 5 and Yang Xie 1, 2, 5 1 Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas, Southwestern Medical Center, Dallas, Texas, USA 2 Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, Texas, USA 3 Department of Cardio Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA 4 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA 5 Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA Correspondence to: David E. Gerber, email: david.gerber@utsouthwestern.edu Yang Xie, email: yang.xie@utsouthwestern.edu Keywords: lung cancer; neoadjuvant chemotherapy; national cancer database Received: September 30, 2017      Accepted: March 27, 2018      Published: May 11, 2018 ABSTRACT Introduction: The current recommendation for the treatment of stage II and III NSCLC is surgery with chemotherapy. While the convention is to administer chemotherapy postoperatively (adjuvant chemotherapy), inconsistent results have been reported regarding the administration of chemotherapy preoperatively (neoadjuvant chemotherapy). Therefore, a comprehensive analysis of neoadjuvant chemotherapy use in NSCLC is needed. Results: Of the 35,134 NSCLC patients identified, 18,684 received surgery alone, 1,154 received surgery with neoadjuvant chemotherapy, and 15,296 received surgery with adjuvant chemotherapy. Race, Charlson-Deyo score, facility type, insurance type and stage of disease are associated with the use of neoadjuvant chemotherapy. In the case of stage II disease, adjuvant chemotherapy showed improved survival (median OS = 80.8 months) over neoadjuvant chemotherapy (OS = 67.0 months) and surgery alone (OS = 51.0 months). For stage III disease, adjuvant chemotherapy (OS = 49.0 months) showed improved survival over surgery alone (OS = 24.3 months), followed by neoadjuvant chemotherapy (OS = 42.0 months). After propensity score matching, adjuvant chemotherapy was found to provide a survival advantage over neoadjuvant in both stage II (HR = 0.70; p = 5.8e-3) and stage III (HR = 0.77; p = 0.011) NSCLC. Conclusions: Our analysis finds a survival advantage for neoadjuvant chemotherapy when compared to surgery alone, but no advantage compared to adjuvant chemotherapy in the treatment of resectable stage II and III NSCLC. Methods: The National Cancer Database (NCDB) was queried for all cases of stage II and III NSCLC from 2006 to 2012. These patients were stratified by stage, and the factors affecting use of neoadjuvant chemotherapy and the effects of neoadjuvant versus adjuvant chemotherapy on overall survival (OS) were investigated.