Multimodal Therapy for T4 N2 Non-Small Cell Lung Cancer With Additional Ipsilateral Pulmonary Nodules.

Background: The optimal treatment strategy for T4 non-small cell lung cancer (NSCLC) with additional intrapulmonary nodules in a different ipsilateral lobe (T4-Add) is not well characterized across clinical N stages. This study evaluated long-term survival of patients with T4-Add N2 NSCLC who received multimodal therapy including surgical resection and chemotherapy vs concurrent chemoradiation. Methods: Patients with T4-Add N2 M0 NSCLC in the National Cancer Database from 2010 to 2015 were included. Long-term survival was evaluated and compared between patients who underwent primary site surgical resection with chemotherapy and those who received concurrent chemoradiation by Kaplan-Meier analysis, Cox proportional hazards modeling, and propensity score matching on 9 common prognostic variables including comorbidities. Results: Of the 499 patients diagnosed with T4-Add N2 M0 NSCLC who satisfied study eligibility criteria, 220 (44.1%) received primary site surgical resection with chemotherapy and 279 (55.9%) received chemoradiation. After multivariable adjusted Cox proportional hazards modeling, surgical resection with chemotherapy was associated with better long-term survival than chemoradiation. In a propensity score-matched analysis of 100 patients who received surgical resection with chemotherapy and 100 patients who received chemoradiation, patients who received surgical resection with chemotherapy had better 5-year overall survival. Conclusions: The results of this national analysis of patients with T4 N2 NSCLC with additional nodules in a different ipsilateral lobe suggest that multimodal therapy including surgery may confer a survival benefit compared with chemoradiation alone. These findings support further evaluation of surgical resection as part of multimodal therapy for carefully selected patients with T4-Add N2 disease.