Resected Non-small Cell Lung Cancer Research Articles

Abstract C025: Identification of cell-cell signaling programs across the tumor-tumor microenvironment ecosystem and associated with clinical status in neoadjuvant osimertinib treated patient samples revealed by spatial profiling

Abstract Lung cancer is the leading cause of cancer mortality, and despite improvements in treatment, tumors typically respond incompletely and resume growth after acquisition of drug resistance. Recent completion of a neoadjuvant osimertinib Phase II trial treating patients with surgically resectable stage I-IIIA EGFR-mutated non-small cell lung cancer (EGFRm NSCLC) (NCT03433469) (Blakely et. Al, JCO 2024) has highlighted the importance of further identifying non-genomic mechanisms of persistence and resistance to targeted therapy. Here we analyzed these patient samples to identify transcriptionally regulated signaling patterns enriched at Residual Disease (RD) after neoadjuvant osimertinib treatment compared to treatment naïve samples (TN), as well as signaling patterns enriched at RD in patients who ultimately develop disease recurrence after surgical resection compared to those who remain disease-free. Spatially resolved transcriptomic sequencing was performed, using the 10X Genomics Visium platform, on 36 tissue sections (n=9 TN, n=19 RD, n=4 Progressive Disease (PD), n=4 Tumor Adjacent Normal), from 25 patients. TN and PD samples were from standard-of-care surgical resections. 18 of 19 RD samples were from NCT03433469. The Visium array spots that tile the sequencing capture area are 55 µm in diameter, and thus can contain an estimated 1-10 cells within each array spot. After quality control, 91,582 array spots remained for downstream analysis. We identified high confidence tumor array spots annotated both as “Cancer” by a board-certified pathologist and with tumor characteristic copy number variations. Through dimensionality reduction clustering, we identified 10 major array spot clusters, including the high confidence tumor array spot cluster. These clusters were further subset into 44 high resolution clusters of array spot niches, 32 of which were shared across at least nine patients. Because array spots are not single-cell resolution, these niches represent spots with similar mixed cell type composition and transcriptional signatures. We identified significant increases in the CCL14+ Endothelial Cell Niche, CXCL2+ Endothelial Cell Niche, Lymphocytes + Endothelial Niche, and CXCL12+ Fibroblast Niche in RD samples compared to TN. We identified a cell signaling program defined by spatially co-expressed ligand-receptor pairs associated with focal adhesion, enriched in PD samples. This same pattern was enriched in RD samples from patients who had recurrent disease after surgical resection compared to RD samples from patients who remained disease free. These data describe an increase in immune trafficking in RD samples, as well as identify an EGFR- alternative signaling pathway correlating with osimertinib resistance. Identification of spatially resolved, differential architectural organization and signaling patterns in RD and PD states will expand our understanding of targeted therapy resistance in EGFRm NSCLC, with the potential to identify additional clinically actionable targets. Citation Format: Whitney Tamaki, Daniel L. Kerr, Wei Wu, Grant Eilers, Anatoly Urisman, Yu-Ting Chou, Philippe Gui, Shigeki Nanjo, Johannes R. Kratz, David M. Jablons, Trever G. Bivona, Collin M. Blakely. Identification of cell-cell signaling programs across the tumor-tumor microenvironment ecosystem and associated with clinical status in neoadjuvant osimertinib treated patient samples revealed by spatial profiling [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C025.

ASO Author Reflections: The Candidate Biomarkers for Predicting Neoadjuvant Immunotherapy in Resectable Non-small Cell Lung Cancer.

ASO Author Reflections: The Candidate Biomarkers for Predicting Neoadjuvant Immunotherapy in Resectable Non-small Cell Lung Cancer.

Divergent clinical and immunologic outcomes based on STK11 co-mutation status in resectable KRAS-mutant lung cancers following neoadjuvant immune checkpoint blockade.

Co-mutations of the KRAS and STK11 genes in advanced non-small cell lung cancer (NSCLC) are associated with immune checkpoint blockade (ICB) resistance. While neoadjuvant chemoimmunotherapy is now a standard of care treatment for resectable NSCLC, the clinical and immunologic impact of KRAS andSTK11 co-mutations in this setting are unknown. We evaluated and compared recurrence-free survival of resectable KRAS-mutated NSCLC tumors, with or without co-occuring STK11 mutations, treated with neoadjuvant ICB. Single cell transcriptomics was performed on tumor-infiltrating T cells from 7 KRASmut/STK11wttumors and 6 KRASmut/STK11mut tumors. Relative to KRASmut/STK11wttumors, KRASmut/STK11mut exhibited significantly higher recurrence risk. Single-cell transcriptomics showed enhanced oxidative phosphorylation with evidence of decreased PGE-2 signaling and increased IL-2 signaling in CD8+ tumor-infiltrating lymphocytes (TIL) from KRASmut/STK11mut tumors, a finding that was mirrored in KRASwt tumors that relapsed. TIL from KRASmut/STK11mut tumors expressed high levels of molecules associated with tumor residence, including CD39 and ZNF683 (HOBIT). These divergent T cell transcriptional fates suggest T cell maintenance and residence may be detrimental to anti-tumor immunity in the context of neoadjuvant ICB for resectable NSCLC, regardless of KRAS mutation status. Our work provides a basis for future investigations into the mechanisms underpinning PGE-2 and IL-2 signaling as they relate to T cell immunity to cancer and to divergent clinical outcomes in KRASmut/STK11mut NSCLC treated with neoadjuvant ICB.

Racial/ethnic differences in survival and treatment response with PD-1/PD-L1 inhibitors in resectable non-small cell lung cancer: a meta-analysis of randomized controlled trials.

The optimal treatment for resectable Non-Small Cell Lung Cancer (NSCLC) remains under investigation, particularly about its effectiveness across different ethnicities. This meta-analysis aims to investigate the potential benefits of adding PD1/PD-L1 inhibitors for treatment, stratified by ethnicity. We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) that investigated the use of PD1/PD-L1 inhibitors to treat patients with resectable NSCLC. The outcomes evaluated were disease-free survival/event-free survival (DFS/EFS), major pathological response (MPR), and pathological complete response (pCR). Hazard ratios (HRs) or risk ratios (RRs) with 95% confidence intervals (CIs) were computed for all endpoints using DerSimonian and Laird random-effects models. Statistical analyses were performed with R Software, version 4.2.3. A total of six RCTs comprising 3,827 patients with NSCLC were included. In populations of Asian descent, PD1/PD-L1 significantly improved DFS/EFS (HR 0.59; 95% CI 0.44-0.78), MPR (RR 5.76; 95% CI 3.58-9.28), and pCR (RR 25.00; 95% CI 6.17-101.36). Similarly, patients of European ancestry experienced significantly improved DFS/EFS (HR 0.77; 95% CI 0.65-0.90), MPR (RR 2.75; 95% CI 2.00-3.77), and pCR (RR 4.53; 95% CI 2.69-7.6) with PD1/PD-L1 therapy. Notably, patients with mixed ethnicity also demonstrated significant improvement in MPR (RR 4.05; 95% CI 2.60-6.33) and pCR (RR 8.44; 95% CI 3.75-19.00) when receiving PD1/PD-L1 inhibitors. This comprehensive meta-analysis suggests that incorporating PD1/PD-L1 inhibitors into treatments offers a promising benefit for patients with resectable NSCLC, regardless of ethnicity. Future studies with in-depth molecular characterization of patients can further refine these findings and potentially guide the development of personalized treatment strategies based on individual ethnic backgrounds.

Clinical characteristics and treatment patterns in early-stage resected non-small cell lung cancer patients: a descriptive retrospective study

Clinical characteristics and treatment patterns in early-stage resected non-small cell lung cancer patients: a descriptive retrospective study

Case report: The effect of induction targeted therapies in stage III driver mutants non-small cell lung cancer

BackgroundOver the past decade, progress in the diagnosis and treatment of Non-Small Cell Lung Cancer (NSCLC) has led to the identification of many targeted mutations. This has enhanced PFS and OS in both advanced and early-stage NSCLC. The current standard of care for stage III NSCLC varies, and it may combine chemotherapy with either immunotherapy or radiotherapy. This study evaluated the role of induction targeted therapies in patients with driver mutations and inoperable NSCLC.MethodsThis is a single-center, retrospective study assessing the efficacy of targeted therapy in resectable stage III NSCLC patients who are EGFR or ALK-positive, using patient records, PET-CT, brain MRI staging, and mediastinal lymph node evaluation.ResultsBetween January 2020 and February 2024, we identified four patients with either EML4-ALK fusions (2/4) or EGFR mutations (2/4) who underwent treatment with brigatinib or osimertinib before surgery. All patients experienced clinical benefits. Of the two patients with ALK fusion, one responded almost completely, while the other exhibited a notable partial response. Among the patients with EGFR mutations, one had a complete response and the other displayed a significant partial response. All four patients subsequently underwent lobectomy surgical resection.ConclusionsThis case series highlights the potential of targeted therapies for resectable NSCLC in the neoadjuvant setting. Further research is required to confirm their benefits, assess their safety and efficacy, and determine optimal timing and sequencing.

Abstract 4112652: Impact of metabolic overweight/obesity phenotypes on clinical outcomes of patients with resectable non-small cell lung cancer in an Asian population

Background: Metabolic syndrome and obesity are known to increase the incidence of lung cancer. We investigated the association between metabolic health and overweight/obesity phenotypes and clinical outcomes in patients with resectable non-small cell lung cancer (NSCLC). Methods: This large retrospective cohort study included adult patients who underwent curative upfront surgery for their stage IA-IIIB NSCLC at a tertiary university hospital from January 2010 to December 2020. They were classified into four phenotypes based on the combination of metabolic health status and body mass index categories: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obesity (MHO), metabolically unhealthy overweight/obesity (MUO). The primary outcomes were disease recurrence and death. Results: Of the 1,513 patients (342 with MHNW, 585 with MUNW, 122 with MHO, and 464 with MUO), patients with the phenotype of MHO were less likely to experience recurrence (MHO [13.1%] vs. MHNW [16.1%] vs. MUNW [22.9%] vs. MUO [19.2%], p = 0.018) and death (MHO [15.6%] vs. MHNW [24.6%] vs. MHUW [31.3%] vs. MUO [24.8%], p < 0.001) compared to those with other 3 phenotypes. Similar results were observed in Kaplan-Meier curves for the primary outcomes according to the four phenotypes (all log-rank P < 0.05). In multivariate Cox regression analyses, both MHO and MUO phenotypes did not increase the risk of recurrence compared to the MHNW phenotype and were associated with improved survival (MHO: adjusted hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.36-0.98, p = 0.040; MUO: adjusted HR 0.76, 95% CI 0.60-0.96, p = 0.022). Conclusions: After curative resection for NSCLC, regardless of metabolic health, patients with overweight/obesity were not at an increased risk of recurrence and paradoxically, had favorable overall survival.

Establishment and Validation of Patient-Derived Non-Small Cell Lung Cancer Organoids as In Vitro Lung Cancer Models

Background: Recent advances in the personalized treatment of non-small cell lung cancer (NSCLC) require representative in vitro model systems that reflect tumor heterogeneity and maintain the characteristic genetic aberrations. We therefore aimed to establish patient-derived NSCLC organoids that offer a reliable platform for further investigations. Methods: NSCLC organoids were cultured between May 2020 and February 2022 from surgically resected NSCLC tissue specimens. After histological and immunohistochemical validation, genetic validation was performed by targeted next-generation sequencing of tissue and organoid specimens using the Oncomine Focus Assay (ThermoFisher Scientific). Results: From 37 resected NSCLC samples, 18 primary organoid cultures were successfully established and expanded during early passages. Upon histomorphological validation, organoids showed complementary characteristics when compared to the resected parental tumor, including adenocarcinoma, squamous cell carcinoma, mucoepidermoid carcinoma, and lung carcinoid differentiation. Among nine parental tumors, traceable genetic alterations were detected, and three corresponding organoids lines retained this mutational profile, including a KRAS p.Gly12Val mutation, KRAS p.Gly12Cys mutation, and RET-fusion. Conclusions: The establishment of primary NSCLC organoids from surgically resected tissue is feasible. Histological, immunohistochemical, and genetic validation is essential to identify representative NSCLC organoids that maintain the characteristics of the parental tumor. Overall, low establishment rates remain a challenge for broad clinical applications.

T-cell Responses to Individualized Neoantigen Therapy mRNA-4157 (V940) Alone or in Combination with Pembrolizumab in the Phase 1 KEYNOTE-603 Study.

mRNA-4157 (V940) is an individualized neoantigen therapy targeting up to 34 patient-specific tumor neoantigens to induce T-cell responses and potentiate antitumor activity. We report mechanistic insights into the immunogenicity of mRNA-4157 via characterization of T-cell responses to neoantigens from the first-in-human, phase 1, KEYNOTE-603 study (NCT03313778) in patients with resected non-small cell lung cancer (Part A: 1-mg mRNA-4157, n = 4) or resected cutaneous melanoma (Part D: 1-mg mRNA-4157 + 200-mg pembrolizumab, n = 12). Safety, tolerability, and immunogenicity were assessed. All patients experienced ≥1 treatment-emergent adverse event; there were no grade 4/5 adverse events or dose-limiting toxicities. mRNA-4157 alone induced consistent de novo and strengthened preexisting T-cell responses to targeted neoantigens. Following combination therapy, sustained mRNA-4157-induced neoantigen-specific T-cell responses and expansion of cytotoxic CD8 and CD4 T cells were observed. These findings show the potential of a novel mRNA individualized neoantigen therapy approach in oncology. Significance: The safety and immunogenicity results from this phase 1 study of mRNA-4157 as adjuvant monotherapy or combination therapy with pembrolizumab show generation of de novo and enhancement of existing neoantigen-specific T-cell responses and provide mechanistic proof of concept to support further development of mRNA-4157 for patients with resected solid tumors. See related commentary by Berraondo et al., p. 2021.

Living on the Edge: Role of Adjuvant Therapy After Resection of Primary Lung Cancer Within 2 Millimeters of a T-Stage Cutoff

ObjectivesWe evaluated the use of systemic therapy and overall survival in patients with resected non-small cell lung cancer (NSCLC) whose pathologic tumor size was within 2mm of a T-stage cutoff. MethodsRetrospective cohort study using the National Cancer Database of patients who underwent resection of tumors within 2mm of the T1c/T2a, T2a/T2b, and T2b/T3 T-stage cutoffs. Patients with nodal involvement or whose T-stage was based on pathologic features other than tumor size were excluded. A multistate model compared the primary outcomes of systemic therapy and overall survival. ResultsFrom the NCDB, 18,490 patients were identified: 9,966 at the T1c/T2a cutoff, 5,593 at the T2a/T2b cutoff, and 2,931 at the T2b/T3 cutoff. Peaks in tumor size distribution occurred at 5mm intervals. Based on an expected normalized curve, 2,050 patients (11.1%) may have been under-staged. Use of systemic therapy was higher among patients with larger tumors at the T1c/T2a cutoff (7.1% vs. 8.9%; p<0.001), the T2a/T2b cutoff (20.0% vs. 25.5%; p<0.001), and the T2b/T3 cutoff (31.2% vs. 41.8%; p<0.001). In a multistate model, mortality was higher above the T1c/T2a cutoff (Hazard Ratio [HR] 1.10; p=0.01), T2a/T2b cutoff (HR 1.17; p<0.01), and T2b/T3 cutoff (HR 1.13; p=0.03). In patients who received systemic therapy, this trend was eliminated (HR 1.24; p=0.14, HR 0.79; p=0.07, and HR 1.23; p=0.09, respectively). ConclusionsRounding of tumor size for pathologic staging is common. While seemingly trivial, rounding may downstage patients and is associated with decreased rates of adjuvant therapy use and potentially worse overall survival.

Brief Report: Prognostic impact of adjuvant immunotherapy in patients with resectable non-small cell lung cancer following neoadjuvant chemoimmunotherapy

ObjectiveThe potential survival benefits of adjuvant immunotherapy for resectable non-small cell lung cancer (NSCLC) following neoadjuvant chemoimmunotherapy, as well as the optimal number of adjuvant immunotherapy cycles, remain uncertain. This study aims to evaluate the prognostic impact of adjuvant immunotherapy and determine the optimal number of cycles. MethodsA total of 438 patients who received neoadjuvant chemoimmunotherapy between August 2019 and June 2022 across four hospitals were enrolled in this study, with a median follow-up time of 31.3 months. Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier methods and tested by log-rank test. Unstratified Cox proportional hazards models were fitted to the subgroups. ResultsIn this multi-center cohort, 29.7% of patients (n=130) achieved a pathologic complete response (pCR). Patients who received adjuvant immunotherapy experienced significant survival benefits compared to those who did not (RFS: hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.41-0.98, P = 0.037; OS: HR 0.27, 95% CI 0.13-0.57, P < 0.001). Subgroup analyses showed that patients with a squamous histologic type, positive PD-L1 expression, and those with a major pathologic response (MPR) particularly benefited from adjuvant immunotherapy. Additionally, we found that six cycles of adjuvant immunotherapy served as a threshold for better prognostic differentiation, suggesting that six or more cycles may be more beneficial. ConclusionsOur study demonstrated that the addition of adjuvant immunotherapy to neoadjuvant chemoimmunotherapy is significantly associated with improved RFS and OS in patients with resectable NSCLC. We also identified that six cycles of adjuvant immunotherapy may be the optimal regimen for these patients.

What Is Best Liquid Remnant for Resected Early-Stage Non-small Cell Lung Cancer?

What Is Best Liquid Remnant for Resected Early-Stage Non-small Cell Lung Cancer?

The role of PD-L1 in patients with non-small cell lung cancer receiving neoadjuvant immune checkpoint inhibitor plus chemotherapy: a meta-analysis

Background: The use of immune checkpoint inhibitors (ICIs) as neoadjuvant therapy is a promising novel approach in resectable non-small-cell lung cancer (NSCLC). This study aimed to investigate the prognostic value of PD-L1 in patients with NSCLC receiving neoadjuvant immune checkpoint inhibitor plus chemotherapy (CT). Materials and methods: Several databases (PubMed, Embase, and cochrane central register of controlled trials [CENTRAL]) were systematically searched. Randomized controlled trials (RCTs) investigating pathological and survival outcomes with neoadjuvant ICI + CT versus CT alone in NSCLC were analyzed. Results: Overall, eight RCTs (n = 3,404) were included. The analyses showed neoadjuvant ICI + CT significantly improved complete pathological response (pCR) and event-free survival (EFS) in either tumor PD-L1 < 1%, ≥ 1%, 1-49%, or ≥ 50% population (both p < 0.0001) compared with neoadjuvant CT alone. The overall survival (OS) data are not yet mature among all included RCTs, and only three RCTs presented OS data by PD-L1 status of patients. The pooled OS favored neoadjuvant ICI + CT in the PD-L1 ≥ 1% population (hazard ratio [HR], 0.45; 95% CI, 0.31–0.65; p < 0.0001), but not in the PD-L1 < 1% population (HR, 0.89; 95% CI, 0.66–1.19; p = 0.43). Conclusions: Compared with neoadjuvant CT alone, neoadjuvant ICI + CT significantly enhanced pCR and EFS for patients with resectable NSCLC regardless of the expression of PD-L1. It seems that only patients with PD-L1 positive tumors may achieve a better OS, but it’s currently inconclusive due to immature data, so future research with long-term follow-up is still needed.

Programmed Cell Death-Ligand 1 Expression and Clinical Outcomes Among Patients with Resected, Early-Stage Non-Small Cell Lung Cancer: A Real-World Study

Treatment options for non-small cell lung cancer (NSCLC) are evolving, given recent and expected approvals of immune checkpoint inhibitors (ICIs) targeting programmed cell death-(ligand) 1 (PD-1/PD-L1). We retrospectively evaluated outcomes among patients with resected stage IB-IIIA NSCLC tumors expressing PD-L1 using PALEOS (Pan-cAnadian Lung cancEr Observational Study) data (2016–2019). Key outcomes included PD-L1 expression rate and treatment patterns, recurrence, and median overall (mOS) and disease-free survival (mDFS) among PD-L1+ patients. Among 539 PD-L1–tested patients, 317 (58.8%) were PD-L1+ (≥1%). At diagnosis, 35.3%, 39.8%, and 24.9% of PD-L1+ patients had stage IB, II, or IIIA disease. Forty-one percent had received adjuvant therapy. At 22.6 months (median follow-up), first disease recurrence had occurred in 31.9% of patients, primarily at metastatic sites. After first metastatic recurrence, ICI regimens were the most common first systemic therapy (29.8%). mOS was not reached; mDFS was 40.0 months. At four years, DFS probability was 44%. Four-year OS and DFS rates were generally similar when stratified by PD-L1 expression (1–49% vs. ≥50%). These findings underscore the generally poor outcomes experienced by patients with early-stage, resected, PD-L1+ NSCLC after treatment with available adjuvant therapies, and provide context to recent and emerging trials of new treatment options.

Importance of driver gene mutation assessment and targeted therapy for patients with early‑stage non‑small cell lung cancer and non‑R0 resection.

Patients with non-small cell lung cancer (NSCLC) and incomplete resection have poor clinical outcomes. The present study aimed to identify risk factors for disease progression and mortality. A total of 65 patients with early-stage NSCLC that underwent operation but had a non-R0 resection between August 2011 and December 2020 were included in the present study, and the clinicopathological features and driver gene mutation status were analyzed. The median follow-up time was 36.2 months; 39 patients (60.0%) experienced disease progression and 3 patients (4.6%) died. In total, 22 patients (33.8%) harbored mutations in driver genes. Multivariate analysis demonstrated that the presence of driver gene mutations was associated with an increased risk of disease progression [adjusted odds ratio, 24.08; 95% confidence interval (CI), 2.77-209.01; P=0.004]. Tumors classed as Eastern Cooperative Oncology Group performance status 2 [adjusted hazard ratio (HR), 3.49; 95% CI, 1.10-11.03; P=0.033], stage II-IIIB tumors (adjusted HR, 2.55; 95% CI, 1.06-6.17; P=0.037) and the presence of a driver gene mutation (adjusted HR, 3.28; 95% CI, 1.55-6.94; P=0.002) were associated with a significantly reduced progression-free survival (PFS). Driver gene-targeted therapy was associated with an increased post-progression survival for patients that were reported to have disease progression (adjusted HR, 0.38; 95% CI, 0.16-0.91; P=0.030). There was no significant impact of driver gene mutation status on the overall survival (OS) of patients. Although the presence of a driver gene mutation was associated with an increased risk of disease progression and a reduced PFS, it was demonstrated that patients with disease progression may benefit from driver gene-targeted therapy, as patients with driver gene-targeted therapy had a similar OS compared with that of patients with a driver gene-negative or unknown status. Therefore, early comprehensive analysis of driver gene mutation status may be recommended for early-stage NSCLC cancer patients experiencing non-R0 resection.

Impact of select actionable genomic alterations on efficacy of neoadjuvant immunotherapy in resectable non-small cell lung cancer

BackgroundNeoadjuvant immune checkpoint inhibitors (ICIs) have improved survival outcomes compared with chemotherapy in resectable non-small cell lung cancer (NSCLC). However, the impact of actionable genomic alterations (AGAs) on the efficacy...

Optimizing lung cancer surgery in the elderly: sublobar resection versus lobectomy for early-stage non-small cell lung cancer patients aged 80 and above

The optimal surgical approach for elderly patients with early-stage non-small cell lung cancer (NSCLC) remains a topic of debate. A retrospective analysis was conducted on patients who underwent pulmonary resection for early-stage NSCLC at our single institution between January 2018 and December 2022. Propensity score matching was used to balance baseline characteristics between the sublobar resection and lobectomy groups. Perioperative outcomes, pulmonary function recovery, postoperative quality of life, and survival were compared between the two groups. A total of 151 patients were included, with 42 undergoing sublobar resection and 109 undergoing lobectomy. After propensity score matching, baseline characteristics were well-balanced between the two groups. Sublobar resection was associated with shorter operative time (125.83 ± 33.56 min vs. 161.14 ± 61.54 min, p = 0.048), less intraoperative blood loss [65 (30, 75) ml vs. 120 (70, 170) ml, p < 0.001], shorter drainage duration [3 (2, 5) days vs. 5 (3, 6) days, p < 0.001], shorter hospital stay [6 (4, 8) days vs. 10 (7, 13) days, p < 0.001], and fewer postoperative complications (11.9% vs. 47.6%, p < 0.001), compared to lobectomy. Moreover, sublobar resection led to better pulmonary function recovery and higher postoperative quality of life scores, with no significant difference in overall and disease-free survival between the groups. Sublobar resection in patients aged 80 and above with early-stage NSCLC offered comparable oncological outcomes to lobectomy while preserving more lung function and providing better postoperative recovery and long-term quality of life. These findings have important implications for treatment decision-making in elderly NSCLC patients.

Impact of PM2.5 exposure on mortality and tumor recurrence in resectable non-small cell lung carcinoma

This study aimed to explore the impact of PM 2.5 exposure on survival, post-operative outcomes, and tumor recurrence in resectable non-small cell lung cancer (NSCLC) patients. The study cohort comprised 587 patients at Chiang Mai University Hospital between January 1, 2010, and December 31, 2017. Patients were categorized based on their residents’ average PM 2.5 concentration into two groups: exposed (PM 2.5 ≥ 25 µg/m3 annual mean) and unexposed (PM 2.5 < 25 µg/m3 annual mean). The exposed group had 278 patients, while the unexposed group had 309 patients. Baseline differences in gender and surgical approach were observed between the groups. Multivariable regression analysis revealed that patients in the exposed group had a higher risk of death (HR 1.44, 95% CI, 1.08–1.89, p = 0.012). However, no significant associations were found between PM 2.5 and post-operative pulmonary complications (RR 1.12, 95% CI, 0.60–2.11, p = 0.718), in-hospital mortality (RR 1.98, 95% CI, 0.40–9.77, p = 0.401), and tumor recurrence (HR 1.12, 95% CI, 0.82–1.51, p = 0.483). In conclusion, a PM 2.5 concentration ≥ 25 µg/m3 annual mean was associated with decreased overall survival and a potential increase in in-hospital mortality among resectable NSCLC patients. Larger studies with extended follow-up periods are required to validate these findings.

OA01.06 A Phase II Study of Perioperative Ivonescimab Alone or Combined with Chemotherapy in Resectable Non-Small Cell Lung Cancer

OA01.06 A Phase II Study of Perioperative Ivonescimab Alone or Combined with Chemotherapy in Resectable Non-Small Cell Lung Cancer

Perioperative immunotherapy for non-small cell lung cancer: consensus and controversy (2024 edition)

Lung cancer is the malignant tumour with the highest morbidity and mortality rate in China, among which non-small cell lung cancer (NSCLC) is the main pathological type of lung cancer, accounting for about 80% to 85%. Radial surgery is the standard treatment for early-stage NSCLC, but postoperative recurrence is an inevitable problem in clinical practice. Adding perioperative chemotherapy to surgery can only increase the 5-year overall survival rate by about 5%. There is an urgent need for better systemic treatments. In recent years, immunotherapeutic drugs, represented by PD-1/PD-L1 monoclonal antibodies, have brought breakthroughs from subsequent-line treatment to front-line treatment for NSCLC. Several Phase III studies on perioperative immunotherapy have shown that adding immunotherapy during the neoadjuvant and adjuvant treatment can significantly improve survival outcomes for patients, leading to the development of a new standard treatment for resectable NSCLC. In January 2024, the first PD-1 monoclonal antibodies (Toripalimab) were approved for perioperative treatment of NSCLC in China, starting a new era of perioperative immunotherapy. At present, there is still a lack of unified consensus on the application of perioperative immunotherapy at all levels of medical institutions. In order to privide diagnostic and treatment guidance for clinicians, promote the standardization of clinical practice for immunotherapy in resectable NSCLC, and clarify the controversial opinions regarding perioperative immunotherapy, Lung Cancer Expert Committee of the Chinese Anti-Cancer Association, Chinese Thoracic Oncology Group, Lung Cancer Expert Committee of the Chinese Medical Association Oncology Society jointly published this Consensus and Controversy to provide a guidance for the standardized management of perioperative immunotherapy for NSCLC.