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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Surgery is the primary treatment modality for non-small cell lung cancer &#40;NSCLC&#41;&#44; but only approximately 20&#37; of tumors are suitable for potentially curative resection and even after surgery&#44; with a high percentage of recurrence probability&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> Therefore&#44; 5-year survival rates after surgery are disappointingly low<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> and new strategies are needed to reduce mortality and recurrence rate in these patients&#46; Stage IB NSCLC therapeutic approach remains a controversial issue&#46; Adjuvant chemotherapy among this particular group of patients has never been demonstrated unequivocally as improving survival&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a></p><p class="elsevierStylePara">Based on recent evidence&#44;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> the National Comprehensive Cancer Network &#40;NCCN&#41; guidelines<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> included an indication for adjuvant chemotherapy for high-risk stage IB NSCLC patients&#46; These high-risk factors include tumor &#62;4&#160;cm&#44; poorly differentiated tumor&#44; vascular invasion&#44; visceral pleura involvement&#44; wedge resection&#44; and incomplete lymph node sampling &#40;Nx&#41;&#46; In order to evaluate the impact of adjuvant chemotherapy on stage IB NSCLC patients undergoing surgery&#44; we reviewed our center experience with these patients&#46;</p><p class="elsevierStylePara">All completely resected stage IB NSCLC patients observed during the period between January 2006 and December 2013 were included&#46; Only patients with proven pT2N0 samples were consecutively enrolled&#46; To ensure maximum homogeneity&#44; patients who had received induction chemotherapy were excluded&#44; even if their definitive staging was pT2N0&#46;</p><p class="elsevierStylePara">We then analyzed the effect of adjuvant chemotherapy&#44; irrespective of the indication&#44; on survival data of all patients included and of a high-risk patients&#8217; subgroup&#44; as defined by the NCCN guidelines&#46; The adjuvant chemotherapy regimen consisted of four courses of a platinum derivative and vinorelbine&#46;</p><p class="elsevierStylePara">We analyzed 27 patients with a mean age of 65&#46;3&#160;&#177;&#160;8&#46;87 years and predominantly male &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;18&#59; 66&#46;7&#37;&#41;&#46; Over 90&#37; of patients had performance status &#8804;1 at diagnosis&#46; There was no perioperative mortality &#40;death within 30 days of surgery&#41;&#46; General and high-risk subgroup population characteristics are presented in <a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#46; Median follow-up time was 52&#46;1 months&#46;</p><p class="elsevierStylePara">Table 1&#46; General population and high-risk subgroup population characteristics&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td colspan="3">General population</td></tr><tr align="left"><td>&#160;</td><td>Adjuvant chemotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;13&#41;</td><td>Non-adjuvant chemotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;14&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Age &#40;mean</span>&#160;<span class="elsevierStyleItalic">&#177;</span>&#160;<span class="elsevierStyleItalic">SD&#41;</span></td><td>62&#46;2&#160;&#177;&#160;7&#46;80</td><td>68&#46;1&#160;&#177;&#160;9&#46;15</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Gender &#40;male&#47;female&#41;</span></td><td>9&#47;4</td><td>9&#47;5</td></tr><tr align="left"><td><span class="elsevierStyleItalic">PS</span>&#160;<span class="elsevierStyleItalic">&#62;</span>&#160;<span class="elsevierStyleItalic">1 &#40;yes&#47;no&#41;</span></td><td>0&#47;13</td><td>2&#47;12</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Histological type</span></td></tr><tr align="left"><td>Adenocarcinoma</td><td>8</td><td>11</td></tr><tr align="left"><td>Squamous cell carcinoma</td><td>4</td><td>3</td></tr><tr align="left"><td>Large cell carcinoma</td><td>1</td><td>0</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Heart disease &#40;yes&#47;no&#41;</span></td><td>2&#47;11</td><td>2&#47;12</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Smoking history &#40;yes&#47;no&#41;</span></td><td>3&#47;10</td><td>4&#47;10</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Resection type</span></td></tr><tr align="left"><td>Pneumonectomy</td><td>1</td><td>3</td></tr><tr align="left"><td>Lobectomy</td><td>11</td><td>6</td></tr><tr align="left"><td>Bilobectomy</td><td>1</td><td>3</td></tr><tr align="left"><td>Wedge resection</td><td>0</td><td>2</td></tr></table><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td colspan="3">High-risk subgroup population</td></tr><tr align="left"><td>&#160;</td><td>Adjuvant chemotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;11&#41;</td><td>Non-adjuvant chemotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;8&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Age &#40;mean</span>&#160;<span class="elsevierStyleItalic">&#177;</span>&#160;<span class="elsevierStyleItalic">SD&#41;</span></td><td>62&#46;1&#160;&#177;&#160;7&#46;94</td><td>71&#46;9&#160;&#177;&#160;8&#46;46</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Gender &#40;male&#47;female&#41;</span></td><td>7&#47;4</td><td>6&#47;2</td></tr><tr align="left"><td><span class="elsevierStyleItalic">PS</span>&#160;&#62;&#160;<span class="elsevierStyleItalic">1 &#40;yes&#47;no&#41;</span></td><td>0&#47;11</td><td>2&#47;6</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Histological type</span></td></tr><tr align="left"><td>Adenocarcinoma</td><td>7</td><td>7</td></tr><tr align="left"><td>Squamous cell carcinoma</td><td>3</td><td>1</td></tr><tr align="left"><td>Large cell carcinoma</td><td>1</td><td>0</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Heart disease &#40;yes&#47;no&#41;</span></td><td>1&#47;10</td><td>2&#47;6</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Smoking history &#40;yes&#47;no&#41;</span></td><td>8&#47;3</td><td>6&#47;2</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Resection type</span></td></tr><tr align="left"><td>Pneumonectomy</td><td>1</td><td>2</td></tr><tr align="left"><td>Lobectomy</td><td>10</td><td>3</td></tr><tr align="left"><td>Bilobectomy</td><td>0</td><td>1</td></tr><tr align="left"><td>Wedge resection</td><td>0</td><td>2</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Num of NCCN risk factors</span></td></tr><tr align="left"><td>1</td><td>5</td><td>5</td></tr><tr align="left"><td>2</td><td>6</td><td>3</td></tr></table><p class="elsevierStylePara">Recurrence was detected in 9 &#40;33&#46;3&#37;&#41; patients &#40;5 in the adjuvant chemotherapy group and 4 in the non-adjuvant chemotherapy group&#41;&#46; Mean disease-free time was 45&#46;3 months for the adjuvant chemotherapy group and 33&#46;6 months for the non-adjuvant chemotherapy group and there was no statistically significant difference between the two groups&#46; Eight &#40;29&#46;6&#37;&#41; deaths occurred in the study group &#40;3 in the adjuvant chemotherapy group and 5 in the non-adjuvant chemotherapy group&#41;&#46; Mean survival time was 50&#46;0 months for the adjuvant chemotherapy group and 36&#46;4 months for the non-adjuvant chemotherapy group and again there was no statistically significant difference between the two groups&#46;</p><p class="elsevierStylePara">As for the high-risk subgroup&#44; 19 patients had at least one NCCN high-risk factor&#46; Mean disease-free time was 43&#46;3 months for the adjuvant group and 32&#46;8 months for the non-adjuvant group&#44; with no statistically significant difference between the two groups&#46; Mean survival time was 48&#46;9 months for the adjuvant chemotherapy group and 34&#46;0 months for the non-adjuvant chemotherapy group&#46; No statistically significant difference was found between the two groups&#46;</p><p class="elsevierStylePara">Our study did not find any clear benefit for the NCCN&#39;s high-risk patients in terms of overall survival and disease-free survival&#44; and the same holds for all NSCLC stage IB patients who underwent surgical treatment&#46; Despite this evidence&#44; we did find a non-significant difference in terms of overall survival and disease free survival between non-adjuvant chemotherapy and adjuvant chemotherapy group&#44; with an improvement of both in the latter group&#46; Although obviously limited by our sample size and by the fact that the non-adjuvant chemotherapy group had a higher ratio of pneumectomies&#44; which is associated with poorer survival&#44;<a href="&#35;bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> this might indicate that adjuvant chemotherapy can play an important role in the treatment of these patients&#46;</p><p class="elsevierStylePara">Unfortunately&#44; adjuvant chemotherapy role in stage IB disease is not established yet&#46; As in our study&#44; subgroup stage IB analyses of larger trials have found a small but non significant overall survival benefit&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> Recent evidence has demonstrated a significant benefit of adjuvant chemotherapy in stage IB patients with larger primary tumors &#40;4&#46;0&#160;cm&#41;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> and the same seems to hold for stage IB patients with vascular invasion&#46;<a href="&#35;bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> In spite of these results&#44; at this point in time there is no available evidence to formally support routine use of adjuvant chemotherapy in stage IB&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a></p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors certify that there were no potential conflicts of interest at the time of redaction of this article&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Authors&#8217; contribution</span><p class="elsevierStylePara">Daniel Coutinho&#44; Ana Antunes and Ana Barroso conceived the project idea&#46; Daniel Coutinho and Ana Gon&#231;alves collected the data&#46; Daniel Coutinho and Ana Antunes conducted the analyses&#46; All authors interpreted and discussed the results&#46; All authors wrote the manuscript&#46; All authors have read and approved the final version&#46;</p><p class="elsevierStylePara">Corresponding author&#46; dpcoutinho&#64;gmail&#46;com</p>"
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Adjuvant chemotherapy in stage IB non-small cell lung carcinoma: A survival analysis
D.. Coutinhoa,
Corresponding author
dpcoutinho@gmail.com

Corresponding author. dpcoutinho@gmail.com
, A.. Gonçalvesa, A.. Antunesa, S.. Campainhaa, J.. Mirandab, A.. Barrosoa
a Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
b Cardiothoracic Surgery Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Surgery is the primary treatment modality for non-small cell lung cancer &#40;NSCLC&#41;&#44; but only approximately 20&#37; of tumors are suitable for potentially curative resection and even after surgery&#44; with a high percentage of recurrence probability&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> Therefore&#44; 5-year survival rates after surgery are disappointingly low<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> and new strategies are needed to reduce mortality and recurrence rate in these patients&#46; Stage IB NSCLC therapeutic approach remains a controversial issue&#46; Adjuvant chemotherapy among this particular group of patients has never been demonstrated unequivocally as improving survival&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a></p><p class="elsevierStylePara">Based on recent evidence&#44;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> the National Comprehensive Cancer Network &#40;NCCN&#41; guidelines<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> included an indication for adjuvant chemotherapy for high-risk stage IB NSCLC patients&#46; These high-risk factors include tumor &#62;4&#160;cm&#44; poorly differentiated tumor&#44; vascular invasion&#44; visceral pleura involvement&#44; wedge resection&#44; and incomplete lymph node sampling &#40;Nx&#41;&#46; In order to evaluate the impact of adjuvant chemotherapy on stage IB NSCLC patients undergoing surgery&#44; we reviewed our center experience with these patients&#46;</p><p class="elsevierStylePara">All completely resected stage IB NSCLC patients observed during the period between January 2006 and December 2013 were included&#46; Only patients with proven pT2N0 samples were consecutively enrolled&#46; To ensure maximum homogeneity&#44; patients who had received induction chemotherapy were excluded&#44; even if their definitive staging was pT2N0&#46;</p><p class="elsevierStylePara">We then analyzed the effect of adjuvant chemotherapy&#44; irrespective of the indication&#44; on survival data of all patients included and of a high-risk patients&#8217; subgroup&#44; as defined by the NCCN guidelines&#46; The adjuvant chemotherapy regimen consisted of four courses of a platinum derivative and vinorelbine&#46;</p><p class="elsevierStylePara">We analyzed 27 patients with a mean age of 65&#46;3&#160;&#177;&#160;8&#46;87 years and predominantly male &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;18&#59; 66&#46;7&#37;&#41;&#46; Over 90&#37; of patients had performance status &#8804;1 at diagnosis&#46; There was no perioperative mortality &#40;death within 30 days of surgery&#41;&#46; General and high-risk subgroup population characteristics are presented in <a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#46; Median follow-up time was 52&#46;1 months&#46;</p><p class="elsevierStylePara">Table 1&#46; General population and high-risk subgroup population characteristics&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td colspan="3">General population</td></tr><tr align="left"><td>&#160;</td><td>Adjuvant chemotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;13&#41;</td><td>Non-adjuvant chemotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;14&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Age &#40;mean</span>&#160;<span class="elsevierStyleItalic">&#177;</span>&#160;<span class="elsevierStyleItalic">SD&#41;</span></td><td>62&#46;2&#160;&#177;&#160;7&#46;80</td><td>68&#46;1&#160;&#177;&#160;9&#46;15</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Gender &#40;male&#47;female&#41;</span></td><td>9&#47;4</td><td>9&#47;5</td></tr><tr align="left"><td><span class="elsevierStyleItalic">PS</span>&#160;<span class="elsevierStyleItalic">&#62;</span>&#160;<span class="elsevierStyleItalic">1 &#40;yes&#47;no&#41;</span></td><td>0&#47;13</td><td>2&#47;12</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Histological type</span></td></tr><tr align="left"><td>Adenocarcinoma</td><td>8</td><td>11</td></tr><tr align="left"><td>Squamous cell carcinoma</td><td>4</td><td>3</td></tr><tr align="left"><td>Large cell carcinoma</td><td>1</td><td>0</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Heart disease &#40;yes&#47;no&#41;</span></td><td>2&#47;11</td><td>2&#47;12</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Smoking history &#40;yes&#47;no&#41;</span></td><td>3&#47;10</td><td>4&#47;10</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Resection type</span></td></tr><tr align="left"><td>Pneumonectomy</td><td>1</td><td>3</td></tr><tr align="left"><td>Lobectomy</td><td>11</td><td>6</td></tr><tr align="left"><td>Bilobectomy</td><td>1</td><td>3</td></tr><tr align="left"><td>Wedge resection</td><td>0</td><td>2</td></tr></table><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td colspan="3">High-risk subgroup population</td></tr><tr align="left"><td>&#160;</td><td>Adjuvant chemotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;11&#41;</td><td>Non-adjuvant chemotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;8&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Age &#40;mean</span>&#160;<span class="elsevierStyleItalic">&#177;</span>&#160;<span class="elsevierStyleItalic">SD&#41;</span></td><td>62&#46;1&#160;&#177;&#160;7&#46;94</td><td>71&#46;9&#160;&#177;&#160;8&#46;46</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Gender &#40;male&#47;female&#41;</span></td><td>7&#47;4</td><td>6&#47;2</td></tr><tr align="left"><td><span class="elsevierStyleItalic">PS</span>&#160;&#62;&#160;<span class="elsevierStyleItalic">1 &#40;yes&#47;no&#41;</span></td><td>0&#47;11</td><td>2&#47;6</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Histological type</span></td></tr><tr align="left"><td>Adenocarcinoma</td><td>7</td><td>7</td></tr><tr align="left"><td>Squamous cell carcinoma</td><td>3</td><td>1</td></tr><tr align="left"><td>Large cell carcinoma</td><td>1</td><td>0</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Heart disease &#40;yes&#47;no&#41;</span></td><td>1&#47;10</td><td>2&#47;6</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Smoking history &#40;yes&#47;no&#41;</span></td><td>8&#47;3</td><td>6&#47;2</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Resection type</span></td></tr><tr align="left"><td>Pneumonectomy</td><td>1</td><td>2</td></tr><tr align="left"><td>Lobectomy</td><td>10</td><td>3</td></tr><tr align="left"><td>Bilobectomy</td><td>0</td><td>1</td></tr><tr align="left"><td>Wedge resection</td><td>0</td><td>2</td></tr><tr align="left"><td colspan="3">&#160;</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">Num of NCCN risk factors</span></td></tr><tr align="left"><td>1</td><td>5</td><td>5</td></tr><tr align="left"><td>2</td><td>6</td><td>3</td></tr></table><p class="elsevierStylePara">Recurrence was detected in 9 &#40;33&#46;3&#37;&#41; patients &#40;5 in the adjuvant chemotherapy group and 4 in the non-adjuvant chemotherapy group&#41;&#46; Mean disease-free time was 45&#46;3 months for the adjuvant chemotherapy group and 33&#46;6 months for the non-adjuvant chemotherapy group and there was no statistically significant difference between the two groups&#46; Eight &#40;29&#46;6&#37;&#41; deaths occurred in the study group &#40;3 in the adjuvant chemotherapy group and 5 in the non-adjuvant chemotherapy group&#41;&#46; Mean survival time was 50&#46;0 months for the adjuvant chemotherapy group and 36&#46;4 months for the non-adjuvant chemotherapy group and again there was no statistically significant difference between the two groups&#46;</p><p class="elsevierStylePara">As for the high-risk subgroup&#44; 19 patients had at least one NCCN high-risk factor&#46; Mean disease-free time was 43&#46;3 months for the adjuvant group and 32&#46;8 months for the non-adjuvant group&#44; with no statistically significant difference between the two groups&#46; Mean survival time was 48&#46;9 months for the adjuvant chemotherapy group and 34&#46;0 months for the non-adjuvant chemotherapy group&#46; No statistically significant difference was found between the two groups&#46;</p><p class="elsevierStylePara">Our study did not find any clear benefit for the NCCN&#39;s high-risk patients in terms of overall survival and disease-free survival&#44; and the same holds for all NSCLC stage IB patients who underwent surgical treatment&#46; Despite this evidence&#44; we did find a non-significant difference in terms of overall survival and disease free survival between non-adjuvant chemotherapy and adjuvant chemotherapy group&#44; with an improvement of both in the latter group&#46; Although obviously limited by our sample size and by the fact that the non-adjuvant chemotherapy group had a higher ratio of pneumectomies&#44; which is associated with poorer survival&#44;<a href="&#35;bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> this might indicate that adjuvant chemotherapy can play an important role in the treatment of these patients&#46;</p><p class="elsevierStylePara">Unfortunately&#44; adjuvant chemotherapy role in stage IB disease is not established yet&#46; As in our study&#44; subgroup stage IB analyses of larger trials have found a small but non significant overall survival benefit&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> Recent evidence has demonstrated a significant benefit of adjuvant chemotherapy in stage IB patients with larger primary tumors &#40;4&#46;0&#160;cm&#41;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> and the same seems to hold for stage IB patients with vascular invasion&#46;<a href="&#35;bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> In spite of these results&#44; at this point in time there is no available evidence to formally support routine use of adjuvant chemotherapy in stage IB&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a></p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors certify that there were no potential conflicts of interest at the time of redaction of this article&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Authors&#8217; contribution</span><p class="elsevierStylePara">Daniel Coutinho&#44; Ana Antunes and Ana Barroso conceived the project idea&#46; Daniel Coutinho and Ana Gon&#231;alves collected the data&#46; Daniel Coutinho and Ana Antunes conducted the analyses&#46; All authors interpreted and discussed the results&#46; All authors wrote the manuscript&#46; All authors have read and approved the final version&#46;</p><p class="elsevierStylePara">Corresponding author&#46; dpcoutinho&#64;gmail&#46;com</p>"
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