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Non-small cell lung cancer with pathological complete response: predictive factors and surgical outcomes

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Abstract

Objectives

When induction therapy followed by surgery for locally advanced non-small cell lung cancer results in pathological complete response, the prognosis is excellent; however, relapses can occur. We analyzed the predictive factors for achieving pathological complete response and reviewed the clinicopathological features and surgical outcomes of locally advanced non-small cell lung cancer with pathological complete response.

Methods

Between March 2005 and January 2015, 145 resections after induction therapy for locally advanced non-small cell lung cancer were performed; 38 cases achieved pathological complete response. Predictive factors for achieving pathological complete response were analyzed, and the clinicopathological features and surgical outcomes of 38 cases with pathological complete response were retrospectively reviewed.

Results

Of 145 patients, 98 underwent induction chemoradiation and 47, induction chemotherapy. Squamous cell carcinoma occurred most frequently (n = 64), followed by adenocarcinoma (n = 53). Only squamous cell carcinoma was positively associated with achieving pathological complete response (p = 0.009). Of 38 patients with pathological complete response, 33 were men and the mean age was 67.0 ± 6.3 years; the clinical stages were IIA (n = 3), IIB (n = 2), IIIA (n = 26), and IIIB (n = 3). One patient died within 30 days post-surgery (2.6%). Eight recurrences occurred during the follow-up period; brain metastasis occurred most frequently. The 5-year overall and recurrence-free survival rates were 79.5% and 72.6%, respectively.

Conclusions

Squamous cell carcinoma was identified as a positive predictive factor for achieving pathological complete response. Among patients undergoing lung cancer surgery after induction therapy with pathological complete response, brain metastasis occurred most frequently.

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Acknowledgements

The authors thank Reiko Moriwake for his painstaking assistance with the data management.

Funding

No funding was provided.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki-City, Okayama, 710-8602, Japan

    Hidenao Kayawake, Norihito Okumura, Keiji Yamanashi, Ayuko Takahashi, Takashi Nakashima & Tomoaki Matsuoka

  2. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan

    Hidenao Kayawake

  3. Department of Radiation Therapy, Kurashiki Central Hospital, Okayama, Japan

    Satoshi Itasaka

  4. Department of Respiratory Medicine, Kurashiki Central Hospital, Okayama, Japan

    Hiroshige Yoshioka

Authors
  1. Hidenao Kayawake
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  2. Norihito Okumura
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  3. Keiji Yamanashi
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  4. Ayuko Takahashi
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  5. Satoshi Itasaka
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Correspondence to Norihito Okumura.

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11748_2019_1076_MOESM1_ESM.tif

Supplemental Figure 1 (A) The overall survival of patients with squamous cell carcinoma who underwent surgical resection after induction therapy was compared between patients receiving and not receiving radiation therapy. There was no significant difference in overall survival. (B) Similarly, there was no significant difference in recurrence-free survival between patients receiving and not receiving radiation therapy (TIF 1342 KB)

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Kayawake, H., Okumura, N., Yamanashi, K. et al. Non-small cell lung cancer with pathological complete response: predictive factors and surgical outcomes. Gen Thorac Cardiovasc Surg 67, 773–781 (2019). https://doi.org/10.1007/s11748-019-01076-9

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  • DOI: https://doi.org/10.1007/s11748-019-01076-9

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