Lung Cancer Surgery after Neoadjuvant Immunotherapy

Plönes, Till; Viehof, J; Darwiche, Kaid; Stuschke, Martin; Schüler, Martin; Aigner, Clemens

doi:10.3390/cancers13164033

Cited by 15 publications

(12 citation statements)

References 71 publications

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“…Moreover, this model is the first prediction model to predict recurrence in stage IA LUAD patients only structured by preoperative blood parameters. Patients with early‐stage LUAD experience local recurrence and distant metastasis due to micrometastasis that cannot be detected by current technology 16,17 . Moreover, previous studies have focused more on postoperative blood parameters, which have led to a delay in the discovery of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram based on preoperative variables for predicting recurrence‐free survival in stage IA lung adenocarcinoma

Xu,

Zeng,

Zhang

et al. 2023

Thoracic Cancer

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BackgroundThis study aimed to establish a nomogram for predicting risk of recurrence and provide a model for decision‐making between lobectomy and sublobar resection in patients with stage IA lung adenocarcinoma.MethodsPatients diagnosed with stage IA lung adenocarcinoma (LUAD) between December 2010 and October 2018 from Cancer Hospital Chinese Academy of Medical Sciences were included. Patients were randomly assigned to training and validation cohorts, accounting for 70% and 30% of the total cases, respectively. We collected laboratory variables before surgery. Univariate and multivariate analyses were performed in the training cohort to identify variables significantly associated with recurrence‐free survival (RFS) which were subsequently used to construct a nomogram. Validation was conducted in both cohorts. A receiver operating characteristic curve was used to determine the optional cutoff values of the scores calculated from the nomogram. Patients were then divided into low‐ and high‐risk groups. Survival was performed to determine if the nomogram could guide the operation method.ResultsA total of 543 patients were included in this study. Gender, albumin level, carcinoembryonic antigen level and cytokeratin‐19‐fragment level were included in the nomogram. In both cohorts, the nomogram stratified the patients into high‐ and low‐risk groups in terms of RFS. In particular, there was a significant difference in RFS between lobectomy and sublobar resection in the high‐risk group.ConclusionsGender, albumin level, carcinoembryonic antigen level and cytokeratin‐19‐fragment level are valuable markers in predicting recurrence and can guide surgical practice in patients with stage IA LUAD.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram based on preoperative variables for predicting recurrence‐free survival in stage IA lung adenocarcinoma

Xu,

Zeng,

Zhang

et al. 2023

Thoracic Cancer

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“…Indeed, the reduction of lymph node involvement and the size of the tumor can result in the resectability of the tumor and also increase the chances of obtaining an anatomically and oncological valid resection (lobectomy or bilobectomy), which is safer than pneumonectomy in terms of morbidity and mortality. Interestingly, new perspectives are developing in terms of the pathological response, with the inclusion of immunotherapy in neoadjuvant settings, with the hope that a good complete response rate may lead to improved survival [24].…”

Section: Discussionmentioning

confidence: 99%

Clinical Stage III NSCLC Patients Treated with Neoadjuvant Therapy and Surgery: The Prognostic Role of Nodal Characteristics

Chiappetta

Tabacco

Iaffaldano

et al. 2022

Life

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BACKGROUND: The aim of this study is to analyze the prognostic factors in patients that underwent induction therapy and surgery for clinical stage III NSCLC. METHODS: Clinical and pathological characteristics of stage III NSCLC patients for N2 involvement that underwent neoadjuvant treatment (NAD) and surgery from 1/01/1998 to 31/12/2017 were collected and retrospectively analyzed. Tumor characteristics, yClinical, yPathological stage and lymph node characteristics were correlated to Overall Survival (OS). RESULTS: The analysis was conducted on 180 patients. Five-year OS (5YOS) was 50.9%. Univariable analysis results revealed old age (p = 0.003), clinical N2 post-NAD (p = 0.01), pneumonectomy (0.005), persistent pathological N2 (p = 0.039, HR 1.9, 95% CI 1.09–2.68) and adjuvant therapy absence (p = 0.049) as significant negative prognostic factors. Multivariable analysis confirmed pN0N1 (p = 0.02, HR 0.29, 95% CI 0.13–0.62) as a favorable independent prognostic factor and adjuvant therapy absence (p = 0.012, HR 2.61, 95% CI 1.23–5.50) as a negative prognostic factor. Patients with persistent N2 presented a 5YOS of 35.3% vs. 55.8% in pN0N1 patients. Regarding lymph node parameters, the lymph node ratio (NR) significantly correlated with OS: 5YOS of 67.6% in patients with NR < 50% vs. 29.5% in NR > 50% (p = 0.029). CONCLUSION: Clinical response aided the stratification of prognosis in patients that underwent multimodal treatment for stage III NSCLC. Adjuvant therapy seemed to be an important option in these patients, while node ratio was a strong prognosticator in patients with persistent nodal involvement.

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“…Systemic immuno-chemotherapy without RT might provide a favorable pathologic response. The efficacy and safety of cICRT shall be examined in future clinical trials, such as the ESPADURVA trial [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recent clinical studies have shown that surgery following chemotherapy with concurrent definitive-dose of radiotherapy is safely performed [ 12 , 13 ]. Again, the safety of surgery following “definitive” cICRT shall be extensively examined in future clinical trials [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Salvage surgery following immuno-chemo-radiotherapy for advanced non-small cell lung cancer

et al. 2022

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Background Salvage surgery following definitive radiotherapy or systemic treatment has become a feasible treatment option in selected patients with advanced initially unresectable non-small cell lung cancer. Recent clinical trials of neoadjuvant treatment have showed that surgery following immuno-chemotherapy is safely performed. Here, we present the first case of salvage surgery following immuno-chemotherapy with concurrent definitive radiotherapy for advanced lung large cell carcinoma. Case presentation A 44-year male was admitted to our hospital for salvage surgery. Ten months prior to this administration, he had been diagnosed with unresectable large cell carcinoma with malignant pericardial effusion (clinical stage IVA/T3N2M1A; no driver-gene alteration) originating from the right upper lobe (RUL). Due to rapid intrabronchial tumor growth causing severe dyspnea, emergency bronchial stenting in the right main bronchus using an expandable metallic stent had been performed. Thereafter, he had received immuno-chemotherapy with concurrent definitive radiotherapy. Despite dramatic radiographic response, he had suffered from persistent and refractory Pseudomonas aeruginosa lung infection associated with bronchial stent placement. As pericardial effusion had disappeared and no distant metastasis had developed, he was diagnosed with a potentially curable disease and was referred to our hospital. An extended sleeve resection was successfully performed, and pathological sections revealed that pathologic complete response was achieved with immuno-chemo-radiotherapy. The patient received no subsequent treatment, and is alive without tumor recurrence at 8 months after surgery. Conclusions Salvage surgery following immuno-chemotherapy with concurrent definitive radiotherapy for advanced non-small cell lung cancer may be feasible in selected patients, and may be considered as a treatment option to control local disease.

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Lung Cancer Surgery after Neoadjuvant Immunotherapy

Cited by 15 publications

References 71 publications

Development and validation of a nomogram based on preoperative variables for predicting recurrence‐free survival in stage IA lung adenocarcinoma

Development and validation of a nomogram based on preoperative variables for predicting recurrence‐free survival in stage IA lung adenocarcinoma

Clinical Stage III NSCLC Patients Treated with Neoadjuvant Therapy and Surgery: The Prognostic Role of Nodal Characteristics

Salvage surgery following immuno-chemo-radiotherapy for advanced non-small cell lung cancer

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