Evaluation of combined pathological responses in primary tumor and lymph nodes following neoadjuvant chemoimmunotherapy in non-small cell lung cancer

Shujie Huang; Junhan Wu; Shaopeng Li; Xianglin Li; Ruijie Zeng; Yong Tang; Jiming Tang; Xiaosong Ben; Dongkun Zhang; Liang Xie; Haiyu Zhou; Gang Chen; Sichao Wang; Zhen Gao; Hansheng Wu; Rixin Chen; Fangping Xu; Guibin Qiao

doi:10.1016/j.lungcan.2023.107401

Evaluation of combined pathological responses in primary tumor and lymph nodes following neoadjuvant chemoimmunotherapy in non-small cell lung cancer

Lung Cancer. 2023 Dec:186:107401. doi: 10.1016/j.lungcan.2023.107401. Epub 2023 Oct 12.

Authors

Shujie Huang¹, Junhan Wu¹, Shaopeng Li², Xianglin Li³, Ruijie Zeng⁴, Yong Tang⁵, Jiming Tang⁵, Xiaosong Ben⁵, Dongkun Zhang⁵, Liang Xie⁵, Haiyu Zhou⁵, Gang Chen⁵, Sichao Wang⁵, Zhen Gao⁵, Hansheng Wu⁶, Rixin Chen⁷, Fangping Xu⁸, Guibin Qiao⁹

Affiliations

¹ Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Shantou University Medical College, Shantou, China.
² Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Thoracic Surgery, the Ninth People's Hospital of Shenzhen, Shenzhen, China.
³ Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
⁴ Shantou University Medical College, Shantou, China; Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
⁵ Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
⁶ Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
⁷ Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Research Center of Medical Sciences, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
⁸ Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China. Electronic address: xfpraider@163.com.
⁹ Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China. Electronic address: guibinqiao@126.com.

PMID: 37844351
DOI: 10.1016/j.lungcan.2023.107401

Abstract

Background: Inconsistent pathological responses of tumor and lymph nodes (LNs) were frequently observed in non-small cell lung cancer (NSCLC) receiving neoadjuvant chemoimmunotherapy. However, there is a lack of studies to report the prognostic significance and the relevant clinicopathological factors of tumor-nodal inconsistent responses after neoadjuvant immunotherapy or chemoimmunotherapy. Therefore, this study aimed to depict the inconsistent pathological combined tumor-nodal responses in NSCLC patients after neoadjuvant chemoimmunotherapy as well as the underlying clinical significance.

Methods: A total of 81 node-positive NSCLC patients who underwent neoadjuvant chemoimmunotherapy were eligible for inclusion. Demographic, radiologic, and pathological features of patients were recorded. Patients with pathological complete response of both tumor (ypT(pCR)) and LNs (ypN0) were classified into the combined good responder group and the relevant clinicopathological features were evaluated. The event-free survival (EFS) outcome was analyzed using Kaplan-Meier analysis.

Results: The ypN0 and ypT(pCR) rates were 74.1 % and 42.0 %, respectively. A significant correlation was observed between ypT(pCR) and ypN0 (P = 0.003), but inconsistent responses remained. The combined responses of the primary tumor and LNs demonstrated a significant association with the prognosis outcome (P = 0.005). Notably,patients who received at least twice of their infusions of immune checkpoint inhibitors after 15:30 had a worse prognosis (P = 0.015).

Conclusion: A significant but not absolute correlation was observed between good tumor response and good nodal response in NSCLC patients after neoadjuvant chemoimmunotherapy, but inconsistent responses were also found. The combination of tumor and nodal responses is significantly associated with prognosis and combined good responder can be used as a reliable prognosis predictor.

Keywords: Event-free survival; Neoadjuvant chemoimmunotherapy; Non-small cell lung carcinoma; Pathological response.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Non-Small-Cell Lung* / drug therapy
Humans
Immunotherapy
Lung Neoplasms* / drug therapy
Lymph Nodes / pathology
Neoadjuvant Therapy
Retrospective Studies