Prognostic potential of ERCC1 protein expression and clinicopathologic factors in stage III/N(2) non-small cell lung cancer

BACKGROUND: Pathological stage III/N(2) non-small cell lung cancer (NSCLC) is heterogeneous, and the optimal prognostic marker for survival remains unclear in Chinese patients. The aim of the present study was to assess the prognostic value of the clinicopathologic features and excision repair cross-complementing group-1 (ERCC1) in resected p-stage III/N(2) NSCLC patients that received cisplatin-based adjuvant chemotherapy. METHODS: Clinical data concerning 115 patients with histopathologically confirmed stage III/N(2) NSCLC who underwent a complete resection were reviewed retrospectively. All patients received cisplatin-based adjuvant chemotherapy. The protein expression levels for ERCC1 were immunohistochemically examined in 115 patients. The relationship between the ERCC1 protein expression level and the clinical outcomes of the patients was then observed. RESULTS: The 5-year survival rate and median survival time of patients with pathological stage III/N(2) NSCLC after surgery and postoperative chemotherapy was 27.0% and 28.0 months, respectively. Survival of patients with ERCC1 negative tumors was significantly longer than those with ERCC1 positive tumors (p = 0.004). However, it was not entirely clear whether adjuvant chemotherapy with cisplatin-based agents was beneficial for ERCC1-negative patients with p-stage III/N(2). A multivariate analysis of survival in patients with stage III/N(2) NSCLC showed that surgical procedure (pneumonectomy vs. lobectomy; p = 0.001), number of involved lymph nodes (≤5 vs. >5; p = 0.001) and ERCC1 protein expression (negative vs. positive; p = 0.012) were significant prognostic factors. In addition, the prognosis of patients with skip mediastinal lymph node metastasis showed a tendency for improved survival, but this was no significant (p = 0.432). CONCLUSIONS: Findings from this retrospective study suggested that the number of involved lymph nodes and the type of pulmonary resection are significant and independent prognosis factors in patients with p-stage III/N(2) NSCLC. In addition, it was found that ERCC1 protein expression might play an important role in the prognosis of p-stage III/N(2) NSCLC patients treated with cisplatin-based adjuvant chemotherapy.