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Upfront surgery for N2 NSCLC: a large retrospective multicenter cohort study

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Abstract

Background

The optimal sequence and combination of surgery, chemotherapy and radiotherapy in patients with N2 non-small cell lung cancer (NSCLC) remain undefined. The aim of our study was to compare two treatment options for N2 NSCLC—induction therapy with subsequent surgery versus upfront surgery with adjuvant treatment.

Methods

We retrospectively reviewed 405 patients with N2 disease in two centers, between January 2010 and December 2016. They were divided into two groups: the Induction Group, composed of patients who received neoadjuvant chemotherapy, and the Upfront surgery Group, composed of patients who underwent surgery as first-line therapy. Propensity score-matched (PSM) analysis was performed, and 52 patients were included in each group. Primary endpoints were: recurrence, overall survival (OS) and disease-free survival (DFS).

Results

After the PSM, no differences were observed in general characteristics, perioperative results, rates and severity of complications, and histopathology results. Seventeen patients (32.7%) of the induction group and 21 (40.4%) of the upfront surgery group had mediastinal lymph nodal involvement with skipping (p = 0.415). Recurrence rate was not different between the two groups (57.7% vs 50.0%, p = 0.478). No differences were observed in terms of OS (40.98 ± 35.78 vs 37.0 ± 40.69 months, p = 0.246) and DFS (29.67 ± 36.01 vs 27.96 ± 40.08 months, p = 0.697). The multivariable analysis identified the pT stage and skipping lymph node metastasis as independent predictive factors for OS.

Conclusions

Upfront surgery followed by adjuvant therapy does not appear inferior in terms of recurrence, OS and DFS, compared to induction chemotherapy with subsequent surgery.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

No funding was used.

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Authors and Affiliations

  1. Thoracic Surgery Department, University and Hospital Trust—Borgo Trento, P.Le A. Stefani, 1-37126, Verona, Italy

    Alessio Campisi, Riccardo Giovannetti & Maurizio Infante

  2. Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua, PD, Italy

    Chiara Catelli & Andrea Dell’Amore

  3. Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland

    Piotr Gabryel, Mariusz Kasprzyk & Cezary Piwkowski

Authors
  1. Alessio Campisi
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  2. Chiara Catelli
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  3. Piotr Gabryel
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  4. Riccardo Giovannetti
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  5. Andrea Dell’Amore
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  6. Mariusz Kasprzyk
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  7. Cezary Piwkowski
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  8. Maurizio Infante
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Contributions

Conceptualization—AC, PG, ADA, MI. Data curation—AC, PG. Formal analysis—AC, PG. Funding acquisition—None. Investigation—AC. Methodology—AC. Project administration—AC, CP, MI. Resources—None. Softwares—AC, RG. Supervision—MI, CP. Validation—RG, MK. Visualization—AC. Writing—original draft—AC, CC, RG. Writing—review & editing—PG, ADA, MI, CP.

Corresponding author

Correspondence to Alessio Campisi.

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Conflict of interest

No conflict of interest to declare.

Ethical approval

The study was approved by the institutional review board of the University of Verona and Karol Marcinkowski University of Medical Sciences of Poznan (the ID approval number was not produced) and written informed consent was obtained from all patients.

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Campisi, A., Catelli, C., Gabryel, P. et al. Upfront surgery for N2 NSCLC: a large retrospective multicenter cohort study. Gen Thorac Cardiovasc Surg 71, 715–722 (2023). https://doi.org/10.1007/s11748-023-01942-7

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  • DOI: https://doi.org/10.1007/s11748-023-01942-7

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