Neoadjuvant chemotherapy for Non-Small-Cell lung cancer: Does it really impact on postoperative outcome after lung resection?

BACKGROUND Although some studies seem to indicate a positive prognostic value of induction chemotherapy in patients with locally advanced Non-Small-Cell Lung Cancer (NSCLC), its impact on postoperative mortality and morbidity is not well established. MATERIALS AND METHODS We reviewed the records of 83 consecutive patients who underwent thoracotomy after induction therapy between 1996 and 2007 (Group 1). Results were compared to those of a control group of 166 patients surgically treated in the same period without prior neoadjuvant therapy (Group 2). RESULTS The two groups were matched for age, sex, histology, comorbidity, respiratory function, and surgical procedure. There was no hospital mortality. Cumulative incidence of major complications was 32% in Group 1 and 37% in Group 2 (p=0.18). The incidence of each complication considered did not significantly differ between the two groups. A higher percentage of patients in Group 1 required blood transfusions (21.7% vs 4.2%, p<0.0001). Multiple logistic regression analysis showed forced expiratory volume in 1 s (FEV1)<75% of predicted (p=0.018) and blood transfusions (p=0.006) to be independent risk factors for major postoperative events in Group 1. DISCUSSION Preoperative chemotherapy did not seem to affect overall morbidity and mortality. Patients with a FEV1B75% of predicted or requiring blood transfusions resulted at increased risk of developing major complications.