Upfront surgery for stage IIIA/B non-small cell lung cancer: retrospective cohort study

Hongsheng Deng; Jun Liu; Xiuyu Cai; Shunjun Jiang; Weixiang Lu; Qing Ai; Jianfu Li; Shan Xiong; Xiangyun Qin; Wenhua Liang; Jianxing He

doi:10.1093/bjsopen/zrae008

Upfront surgery for stage IIIA/B non-small cell lung cancer: retrospective cohort study

BJS Open. 2024 Mar 1;8(2):zrae008. doi: 10.1093/bjsopen/zrae008.

Authors

Hongsheng Deng¹, Jun Liu¹, Xiuyu Cai², Shunjun Jiang^{1

3}, Weixiang Lu¹, Qing Ai¹, Jianfu Li¹, Shan Xiong¹, Xiangyun Qin⁴, Wenhua Liang¹, Jianxing He¹

Affiliations

¹ Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
² Department of General Internal Medicine, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China.
³ Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
⁴ LinkDoc Technology Co. Ltd, Beijing, China.

Abstract

Background: Stage III non-small cell lung cancer is a heterogeneous disease. Several international guidelines recommend neoadjuvant treatment before surgery; however, upfront surgery is the preferred approach for technically resectable non-small cell lung cancer in East Asia. The aim of this retrospective study was to evaluate the long-term outcomes of curative-intent upfront surgery in stage IIIA/B non-small cell lung cancer.

Methods: Patients who underwent curative-intent upfront surgery with stage cIIIA/B non-small cell lung cancer were identified. The clinical and pathological variables and survival outcomes were evaluated.

Results: Overall, 664 patients were identified, of whom 320 (48.8%) had N2 disease, 66.7% were males, 49.4% had a smoking history, and 61.2% had lung adenocarcinoma. Lobectomy was the most performed surgical procedure (84.9%). A total of 40 patients (6.02%) had positive margins (R1/R2). The grade III adverse event rate was 2.0% (13 of 664). The median follow-up was 30.6 (range 1.9-97.7) months. At follow-up, the mortality rate was 13.3% (88 of 664) and 37.2% of patients (247 of 664) had recurrence. Lung (101 of 247 (40.9%)) and brain (53 of 247 (21.5%)) were the most common sites of recurrence. The median overall survival was 60.0 (95% c.i. 51.5 to 67.6) months, with overall survival probability at 1, 2, 3, and 5 years being 89.6%, 77.8%, 67.2%, and 49.0% respectively. The R0 cohort showed an improved median overall survival compared with the R1/R2 cohort (67.4 versus 26.5 months respectively; P = greater than 0.001). The multivariable analysis revealed that age greater than or equal to 65 years (HR 1.51, 95% c.i. 1.08 to 2.12; reference = age less than 65 years), tumour size (greater than or equal to 5 cm (HR 2.13, 95% c.i. 1.41 to 3.21) and greater than or equal to 3 cm but less than 5 cm (HR 1.15, 95% c.i. 0.78 to 1.71); reference = less than 3 cm), and adjuvant treatment (chemotherapy (HR 0.69, 95% c.i. 0.49 to 0.96) and targeted therapy (HR 0.30, 95% c.i. 0.12 to 0.76); reference = none) significantly predicted overall survival.

Conclusion: Upfront surgery is an option for the management of stage IIIA/B non-small cell lung cancer.

MeSH terms

Aged
Carcinoma, Non-Small-Cell Lung* / drug therapy
Carcinoma, Non-Small-Cell Lung* / surgery
Female
Humans
Lung Neoplasms* / surgery
Male
Neoplasm Staging
Retrospective Studies
Treatment Outcome