Generic placeholder image

Reviews on Recent Clinical Trials


ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Research Article

Is Surgery Worthwhile in Locally-advanced NSCLC Patients with Persistent N2-disease After Neoadjuvant Therapy?

Author(s): Filippo Lococo*, Marco Chiappetta*, Corolina Sassorossi, Dania Nachira, Jessica Evangelista, Leonardo Petracca Ciavarella, Maria Teresa Congedo, Venanzio Porziella, Luca Boldrini, Annarila Larici, Emilio Bria and Stefano Margaritora

Volume 17, Issue 2, 2022

Published on: 13 July, 2022

Page: [103 - 108] Pages: 6

DOI: 10.2174/1574887117666220518102321

Price: $65


Aims: To explore the long-term survival in lung cancer patients with persistent mediastinal lymph nodal disease after neoadjuvant followed by surgical resection and to analyse prognostic factors in this specific subset of patients.

Background: Surgery in non-small-cell lung cancer (NSCLC) patients with N2-disease after neoadjuvant therapy (NAD) has been debated and has been even more questioned with the advent of immunotherapy.

Objective: Describe long-term results of a multimodal approach in locally-advanced NSCLC patients with persistence of N2-disease and identify prognostic factors to target the strategy of care.

Methods: We retrospectively reviewed data of 121 consecutive Stage IIIA-N2 NSCLC patients who underwent NAD (chemoradiotherapy or chemotherapy) from 01/00 to 12/19, focusing our analysis on 37 patients with persistent N2s status after surgery. Kaplan-Meier and Cox regression analysis explored the associations between mortality and potential risk factors.

Results: The 5-year survival was 29.8%. Cox regression analysis suggested that young age (HR=0.98, C.I.95%: 0.97- 1.00; p=0.062), male sex (HR=3.8,C.I.95%:1.06-13.73;p=0.04), and adjuvant therapy (HR=6.81,C.I.95%:0.96-53.94;p=0.06) influenced long-term outcomes in these patients.

Conclusion: We herein observed suboptimal long-term results in this NSCLC patient subset, and, considering emerging results adopting immunotherapy following chemoradiotherapy, surgery should be carefully considered in very selected cases (young and clinically fit patients) and combined with adjuvant therapy after surgery.

Keywords: Neoadjuvant therapy, surgery, lung cancer, lymph nodes, chemotherapy, radiotherapy.

Next »
International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012 Lung Cancer. In: World Health Organization International Agency for Research on Cancer; , 2012.
Antonia, S.J.; Villegas, A.; Daniel, D. PACIFIC Investigators. Overall survival with durvalumab after chemoradiotherapy in stage III NSCLC. N. Engl. J. Med., 2018, 379(24), 2342-2350.
[] [PMID: 30280658]
Vansteenkiste, J.; Wauters, E.; Reymen, B.; Ackermann, C.J.; Peters, S.; De Ruysscher, D. Current status of immune checkpoint inhibition in ear-ly-stage NSCLC. Ann. Oncol., 2019, 30(8), 1244-1253.
[] [PMID: 31143921]
Trodella, L.; Granone, P.; Valente, S. Neoadjuvant concurrent radiochemotherapy in locally advanced (IIIA-IIIB) non-small-cell lung cancer: Long-term results according to downstaging. Ann. Oncol., 2004, 15(3), 389-398.
[] [PMID: 14998840]
Port, J.L.; Korst, R.J.; Lee, P.C. Surgical resection for residual N2 disease after induction chemotherapy. Ann. Thorac. Surg., 2005, 79(5), 1686-1690.
[] [PMID: 15854955]
Lococo, F.; Sassorossi, C.; Nachira, D. Prognostic factors and long-term survival in locally advanced NSCLC with pathological complete response after surgical resection following neoadjuvant therapy. Cancers, 2020, 12(12), E3572.
[] [PMID: 33265905]
Vansteenkiste, J.F.; De Leyn, P.R.; Deneffe, G.J. Leuven Lung Cancer Group. Survival and prognostic factors in resected N2 non-small cell lung cancer: A study of 140 cases. Ann. Thorac. Surg., 1997, 63(5), 1441-1450.
[] [PMID: 9146340]
Meacci, E.; Cesario, A.; Cusumano, G. Surgery for patients with persistent pathological N2 IIIA stage in non-small-cell lung cancer after induction radio-chemotherapy: The microscopic seed of doubt. Eur. J. Cardiothorac. Surg., 2011, 40(3), 656-663.
[] [PMID: 21402479]
Shinde, A.; Horne, Z.D.; Li, R. Optimal adjuvant therapy in clinically N2 non-small cell lung cancer patients undergoing neoadjuvant chemotherapy and surgery: The importance of pathological response and lymph node ratio. Lung Cancer, 2019, 133, 136-143.
[] [PMID: 31200820]
Gray, J.E.; Villegas, A.; Daniel, D. Three-year overall survival with durvalumab after chemoradiotherapy in stage III NSCLC-update from PACIFIC. J. Thorac. Oncol., 2020, 15(2), 288-293.
[] [PMID: 31622733]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy