Abstract
Simple SummaryEvidence-based guidelines provide valuable management recommendations that can significantly improve patient treatment and outcome, thereby reducing clinical variability. Recent clinical trials demonstrated that personalised treatments based on genomic and immune profiles can contribute to the prognosis of non-small cell lung cancer (NSCLC). This retrospective study investigated whether guideline-consistency, including adjuvant treatments after surgical resection (ATSR) and guideline-matched first-line treatment for recurrence (GMT-R), could influence overall survival (OS). From 2006 to 2017, 308 patients with pathological stage III NSCLC were eligible, among whom 207 (67.2%) recurrence cases were identified. ATSR and GMT-R were allowed in 164 (53.2%) and 129 (62.3%) cases, respectively. The 5-year OS in guideline-consistent cases receiving ATSR and GMT-R was significantly better than that in guideline-inconsistent cases (p < 0.01). Subgroup analyses further revealed that the 5-year OS after propensity adjustment was significantly better in guideline-consistent than in guideline-inconsistent cases (p < 0.01). Hence, guideline-consistent treatment alternatives effectively contribute to better outcomes.Clinical guidelines can help reduce the use of inappropriate therapeutics due to localism and individual clinician perspectives. Nevertheless, despite the intention of clinical guidelines to achieve survival benefit or desirable outcomes, they cannot ensure a robust outcome. This retrospective study aimed to investigate whether guideline-consistency, including adjuvant treatments after surgical resection (ATSR) and guideline-matched first-line treatment for recurrence (GMT-R), according to the genomic profiles and immune status, could influence overall survival (OS). From 2006 to 2017, the clinical data of 308 patients with stage III non-small cell lung cancer (NSCLC) after surgical resection were evaluated. ATSR and GMT-R were allowed in 164 (53.2%) and 129 (62.3%) patients cases after surgical pulmonary resection, among which 207 (67.2%) recurrences were identified. The 5-year OS in guideline-consistent cases was significantly better than that in guideline-inconsistent cases (p < 0.01). Subgroup analyses further showed that the 5-year OS after propensity adjustment was significantly better in guideline-consistent than in guideline-inconsistent cases (p < 0.01), but not in either ATSR or GMT-R (p = 0.24). These data suggest that the guideline-consistent alternatives, which comprise ATSR or GMT-R, can contribute to survival benefits in pathological stage III NSCLC. However, only either ATSR or GMT-R has a potential survival benefit in these patients.
Highlights
The landscape of anticancer agents available in the clinical setting has significantly evolved over the past 50 years
This study focused on two main key words in perioperative clinical guidelines: ‘adjuvant treatments after surgically resection’ (ATSR) and ‘guideline-matched first-line treatment for recurrence’ (GMT-R)
Between January 2006 and December 2017, 308 patients with surgically resected non-small cell lung cancer (NSCLC) were diagnosed with pN2
Summary
The landscape of anticancer agents available in the clinical setting has significantly evolved over the past 50 years. The combination of chemotherapy with cisplatin to target non-small cell lung cancer (NSCLC) that has progressed has allowed the support of a mean length of life of 8–12 months. In the 21st century, due to the bright results of molecular targeted techniques, genome medicine, and immunobiology, the diagnostic and therapeutic efficacy for NSCLC has greatly progressed. These advances have paved the way for physicians and surgeons to be realistically able to see results from translational research. A strategy to unify fragmented treatment and, thereby, improve treatment efficacy in clinical practice is indispensable
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