Effect of Postoperative Adjuvant Chemotherapy with Tegafur-Uracil on Survival in Patients with Stage IA Non-small Cell Lung Cancer An Exploratory Analysis from a Meta-Analysis of Six Randomized Controlled Trials

Background: The Seventh Edition of the Tumor, Node, Metastasis Classification of Malignant Tumors in non-small cell lung cancer (NSCLC) proposes a more detailed classification of primary tumor diameter. Stage IA T 1 disease is subdivided into two groups: T 1 a disease (tumor diameter, <= 2 cm) and T1b disease (tumor diameter, >2 to <= 3 cm). Tegafur-uracil (UFT) improves survival in patients with stage I NSCLC. However, whether it is effective in patients with T1 disease (stage IA) remains controversial. Methods: Data from a 2005 meta-analysis of UFT were reanalyzed to evaluate the effectiveness of UFT according to T1a and T1b tumors as proposed by the new tumor, node, metastasis classification in patients who had T1 tumors with no lymph-node metastasis. Results: Data from 1269 patients were analyzed: 670 (52.8%) had T 1 a tumors and 599 (47.2%) had T1b tumors. In the surgery-alone group, survival rates at 5 years were 85% in patients with T I a tumors and 82% in those with T1b tumors after surgery alone and 87% in patients with T1a tumors and 88% in those with T1b tumors after surgery followed by adjuvant treatment with UFT. In patients with T1b tumors, the survival rate was significantly higher in the LIFT group than in the surgery-alone group (hazard ratio = 0.62; 95% confidence interval, 0.42-0.90; log-rank p = 0.011). The hazard ratio for death in the UFT group when compared with the surgery-alone group was 0.84 for those with T1a disease (95% confidence interval, 0.58-1.23). The results of a test for interaction between treatment response and T1 subgroup were not significant (p = 0.30). Conclusions: LIFT significantly improves survival in patients with stage IA T1b NSCLC compared with surgery alone.