Abstract

Simple SummaryHigher response may be achieved with induction therapy (IT) and better survival results could be expected after complete surgical resection for non-small-cell lung cancer (NSCLC) patients. Thus, locally advanced (LA)-NSCLC patients with pathological complete response (pCR) are optimal candidates to undergo surgery after IT, achieving good to very good long-term survival. Herein, we performed a retrospective analysis on a large cohort of locally advanced NSCLC patients who achieved pCR after IT and surgery, exploring long-term survival and factors affecting prognosis. We observed a rewarding 5-year overall survival (56%) with baseline N2 single-station disease and adjuvant therapy after surgery associated with better prognosis. These findings may be useful to better define the strategy of care in this highly selected subset of NSCLC patients.Background: Outcomes for locally advanced NSCLC with pathological complete response (pCR), i.e., pT0N0 after induction chemoradiotherapy (IT), have been seldom investigated. Herein, long-term results, in this highly selected group of patients, have been evaluated with the aim to identify prognostic predictive factors. Methods: Patients affected by locally advanced NSCLC (cT1-T4/N0-2/M0) who underwent IT, possibly following surgery, from January 1992 to December 2019, were considered for this retrospective analysis. Survival rates and prognostic factors have been studied with Kaplan-Meier analysis, log-rank and Cox regression analysis. Results: Three-hundred and forty-three consecutive patients underwent IT in the considered period. Out of them, 279 were addressed to surgery; among them, pCR has been observed in 62 patients (18% of the total and 22% of the operated patients). In the pCR-group, clinical staging was IIb in 3 (5%) patients, IIIa in 28 (45%) patients and IIIb in 31 (50%). Surgery consisted of (bi)lobectomy in the majority of cases (80.7%), followed by pneumonectomy (19.3%). Adjuvant therapy was administered in 33 (53.2%) patients. Five-year overall survival and disease-free survival have been respectively 56.18% and 48.84%. The relative risk of death, observed with the Cox regression analysis, was 4.4 times higher (95% confidence interval (CI): 1.632–11.695, p = 0.03) for patients with N2 multi-station disease, 2.6 times higher (95% CI: 1.066–6.407, p = 0.036) for patients treated with pneumonectomy and 3 times higher (95% CI: 1.302–6.809, p = 0.01) for patients who did not receive adjuvant therapy. Conclusions: Rewarding long-term results could be expected in locally advanced NSCLC patients with pCR after IT followed by surgery. Baseline N2 single-station disease and adjuvant therapy after surgery seem to be associated with better prognosis, while pneumonectomy is associated with poorer outcomes.

Highlights

  • Lung cancer remains the leading cause of cancer mortality worldwide, accounting for 1.8 million new diagnoses per year (13% of all diagnosed cancers) [1]

  • Both surgery and other oncological treatments alone are not sufficient to control locally advanced (LA)-Non-small-cell lung cancer (NSCLC), which justifies preferring a combined approach with induction therapy (IT) followed by surgery when clinically feasible, and especially when a mediastinal downstaging or a pathological complete response (pCR) has been achieved in the neoadjuvant setting [8]

  • Reviewing the largest clinical series reported in the literature, the rates of pCR for patients with LA-NSCLC treated with neoadjuvant therapy range between 8% and 45%, depending on the IT approach used [10,11,13,16,17,18]

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Summary

Introduction

Lung cancer remains the leading cause of cancer mortality worldwide, accounting for 1.8 million new diagnoses per year (13% of all diagnosed cancers) [1]. Represents more than 80% of total lung cancer cases, of which 19% are early-stage, 25% are locally advanced and 56% present with distant metastases ab initio [2]. While survival has increased in the last decades and guidelines substantially agree on the therapeutic pathway for early-stage lung cancer, the strategy of care for locally advanced (LA) NSCLC (mostly N2 disease) has not been adequately standardized and survival outcomes are so far almost disappointing, with no remarkable improvements in the last 30 years. Long-term results, in this highly selected group of patients, have been evaluated with the aim to identify prognostic predictive factors. Methods: Patients affected by locally advanced NSCLC (cT1-T4/N0-2/M0) who underwent IT, possibly following surgery, from January 1992 to December. 279 were addressed to surgery; among them, pCR has been observed in 62 patients

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