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초록
Purpose
To evaluate the compliance of patients who underwent complete resection of non-small cell lung cancer (NSCLC) with adjuvant chemotherapy.
Materials and Methods
Between January 2004 and May 2006, patients who underwent a complete resection for NSCLC were referred to oncologists for adjuvant chemotherapy. Three or 4 cycles of platinum-based adjuvant chemotherapy was then performed according to the protocol or the preference of the oncologists.
Results
Two hundred and thirty-two patients were enrolled in this study. The median age of the study group was 60.9 years and 76.7 % of the patients enrolled were male. 34.9%, 28.8% and 36.2% of the patients were in stage IB, II and III respectively. In addition, 142 of the patients (61.2%) completed all planned cycles, whereas 65 patients (28%) received no therapy. The causes of start failure for adjuvant chemotherapy consisted of decreased postoperative performance status (n=39), refusal (n=13) and distant metastasis at the initial follow-up (n=2). The causes of cessation during adjuvant chemotherapy included the occurrence of severe adverse effects (n=12), aggravation of the disease with newly developed metastasis (n=4) and others (n=6). The mortality related to the adjuvant chemotherapy was 1.3 % (n=3), all of the fatalities were due to pneumonia and sepsis. Univariate analysis showed that age, postoperative complications and pathologic staging were the significant factors that determined whether the adjuvant chemotherapy was completed. Multivariate analysis demonstrated statistically significant differences in compliance when age and pathologic staging were considered.
Conclusion
Adjuvant chemotherapy for completely resected NSCLC was performed with satisfactory compliance in approximately 60% of the patients included in this study, and age plays an important role in the compliance of adjuvant chemotherapy. Elderly subsets will be examined to help determine the effect of age on compliance and outcome. In addition, the medical oncologist tended to complete the adjuvant chemotherapy for more advanced cases of lung cancer than for stage IB lung cancer.
References
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Fig. 1.
Adjuvant chemotherapy treatment flow from thoracic surgeons to medical oncologist. NSCLC: non-small cell lung cancer.
Table 1.
Patient Characteristics (n=232)
| Variables | Number (%) |
|---|---|
| Male | 178 (76.7) |
| Operation procedure | |
| Lobectomy | 207 (89.2) |
| Pneumonectomy | 25 (10.8) |
| VATS* | 20 (8.6) |
| Histology | |
| Squamous cell carcinoma | 115 (49.6) |
| Adenocarcinoma | 95 (40.9) |
| Others | 22 (9.5) |
| Pathologic staging | |
| Stage IB | 81 (34.9) |
| Stage IIA | 8 (3.5) |
| Stage IIB | 59 (25.4) |
| Stage IIIA | 84 (36.2) |
| Chemotherapy start failure | 65 (28.0) |
| Chemotherapy regimen | |
| GemzarⓇ+Cisplatin (GP) | 79 (34.1) |
| TaxolⓇ+Cisplatin (TP) | 46 (19.8) |
| GemzarⓇ+Carboplatin (GC) | 4 (1.7) |
| TaxolⓇ+Carboplatin (TC) | 14 (6.0) |
| Navelbine+Cisplatin (NP) | 6 (2.6) |
| Irinotecan+Cisplatin (IP) | 5 (2.2) |
| Etoposide+Cisplatin (EP) | 6 (2.6) |
| Others | 7 (3.0) |
Table 2.
Univariate Analysis according to the Completion of Adjuvant Chemotherapy
| Variables | Completion (n=142) | Discontinuation (n=25) | p value | None (n=65) | p value |
|---|---|---|---|---|---|
| Age (year) | 59.0±8.9 | 59.4±10.9 | 0.847 | 65.4±6.8 | ＜0.001 |
| Sex (male/female) | 104/38 | 19/6 | 0.813 | 55/10 | 0.085 |
| Preop. PFT* | |||||
| FEV1 (liter)† | 2.37±0.65 | 2.52±0.51 | 0.283 | 2.27±0.56 | 0.144 |
| FEV1 (%) | 91.4±20.2 | 94.1±19.5 | 0.536 | 91.6±18.5 | 0.940 |
| FVC (liter)‡ | 3.26±0.71 | 3.39±0.69 | 0.358 | 3.19±0.76 | 0.380 |
| FVC (%) | 90.4±14.11 | 90.7±14.8 | 0.912 | 89.2±13.77 | 0.551 |
| Smoking | 100 | 15 | 0.350 | 53 | 0.071 |
| Pneumonectomy | 17 | 2 | 0.742 | 6 | 0.653 |
| Pathologic staging | 0.616 | 0.045 | |||
| IB | 43 | 5 | 1 | ||
| IIA | 7 | 0 | 18 | ||
| IIB | 38 | 8 | |||
| IIIA | 54 | 12 | |||
| Histology | 0.328 | 0.076 | |||
| Adenocarcinoma | 61 | 13 | 40 | ||
| Squamous cell ca. | 67 | 8 | 0.076 | ||
| Others | 14 | 4 | |||
| Operation time (minutes) | 192.3±59.5 | 210.6±92.1 | 0.346 | 205.4±57.6 | 0.266 |
| In-hospital stay (days) | 11.9±3.4 | 13.6±6.5 | 0.065 | 15.6±14.2 | 0.064 |
| VATS§ | 14 | 1 | 0.474 | 5 | 0.492 |
| Postoperative complications | 41 | 6 | 0.644 | 30 | 0.013 |
| Interval from surgery to | |||||
| chemotherapy (days) | 34.5±8.8 | 36.6±9.9 | 0.297 | – | – |
Table 3.
Multivariate Analysis of Adjuvant Chemotherapy
| Variables | p value | Odds ratio | 95% CI |
|---|---|---|---|
| Sex | 0.347 | 1.993 | 0.473∼8.393 |
| Age | ＜0.001 | 0.895 | 0.850∼0.943 |
| Operation time | 0.687 | 0.999 | 0.994∼1.004 |
| In-hospital stay | 0.136 | 0.949 | 0.885∼1.017 |
| Histology | 0.367 | 1.151 | 0.643∼2.06 |
| Postoperative | |||
| complications | 0.229 | 0.636 | 0.304∼1.33 |
| Smoking | 0.867 | 0.893 | 0.239∼3.342 |
| FEV1* | 0.761 | 0.903 | 0.469∼1.741 |
| Pathologic staging | 0.045 |
Table 4.
Stage Response and Toxicity in Adjuvant Chemotherapy Trials for NSCLC
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