Abstract
Aim
The first aim is to determine the clinical and pathological characteristics and factors affecting survival in patients with pathological complete response (pCR) after neoadjuvant therapy, and the secondary aim is to investigate the effect of adjuvant therapy on survival in these patients.
Methods
Between 2003 and 2015, there was 372 patients who underwent lung resection after neoadjuvant therapy with a diagnosis of locally advanced lung cancer. Sixty-eight patients who had pCRwere retrospectively analyzed. The odds ratios (OR) were calculated in regards of recurrence.
Results
Overall 5-year survival rate was 65.1%. Recurrence was the risk factor affecting survival (78.2% vs 19.3%, p = 0.001) while neoadjuvant treatment type (p = 0.766), the reason of neodjuvant treatment (p = 0.581), and the type of operation (p = 0.860) did not affect survival. Postoperative adjuvant treatment had a positive effect on survival (71.1% versus 62.7%), although this difference was not significant (p = 0.561). Local or distant recurrence was detected in 15 patients (22%). In multivariate analysis, the independent risk factors affecting the recurrence were the time from the end of the neoadjuvant therapy to the surgery being less than eight weeks (OR = 6.49, p = 0.03), the type of neoadjuvant treatment (OR = 0.203, p = 0.03). In patients with a squamous cell carcinoma, there was a decreased trend toward in terms of recurrence (p = 0.06).
Conclusions
pCR after neoadjuvant therapy positively affects survival. Better survival may be detected in patients receiving adjuvant therapy. Due to unexpected the high recurrence rate, patients should be followed in the postoperative period closely.
Similar content being viewed by others
Reference
Kim Anthony W, et al. Neoadjuvant chemoradiation for clinically advanced non-small cell lung cancer: an analysis of 233 patients. The Ann Thorac Surg. 2011;92(1):233–43.
Trodella LUCIO, et al. Neoadjuvant concurrent radiochemotherapy in locally advanced (IIIA–IIIB) non-small-cell lung cancer: long-term results according to downstaging. Ann Oncol. 2004;15(3):389–98.
Filippo L, et al. Long-term results in patients with pathological complete response after induction radiochemotherapy followed by surgery for locally advanced non-small-cell lung cancer. Eur J Cardio-Thora Surg. 2013;43(3):e71–81.
Detterbeck Frank C, et al. Screening for lung cancer: diagnosis and management of lung cancer: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2013;143(5):e78S-e92S.
Hüseyin M, et al. Pathological complete response after neoadjuvant/induction treatment: where is itsplace in thelungcancerstagingsystem? Eur J Cardio-Thorac Surg. 2019;56(3):604–11.
Cerfolio Robert J, Maniscalco L, Bryant AS. The treatment of patients with stage IIIA non-small cell lung cancer from N2 disease: who returns to the surgical arena and who survives. The Ann Thorac Surg. 2008;86(3):912–20.
Junker K, et al. Tumour regression in non-small-cell lung cancer following neoadjuvant therapy. Histological assessment. J Cancer Res Clin Oncol. 1997;123(9):69–477.
Travis WD, et al. IASLC Multidisciplinary recommendations for pathologic assessment of lung cancer resection specimens after neoadjuvant therapy. J Thorac Oncol. 2020;15(5):709–40.
Rusch VW, et al. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4(5):568–77.
Hisao A, et al. The international association for the study of lung cancer lung cancer staging project: proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol. 2015;10(12):1675–84.
Shin-ichi T. Results of pulmonary resection following neoadjuvant therapy for locally advanced (IIIA–IIIB) lung cancer. Eur J Cardiothorac Surg. 2006;30(1):184–9.
Alberts WM. Diagnosis and management of lung cancer executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2007;132(3):1S-19S.
Ginsberg RJKM. Non-small cell lung cancer. Cancer, principles and practice of oncology 1997;858–911.
Martini N. Prospective study of 445 lung carcinomas with mediastinal lymph node metastases. J Thorac Cardiovasc Surg. 1980;80:390–9.
Gilligan D, et al. Preoperative chemotherapy in patients with resectable non-small cell lung cancer: results of the MRC LU22/NVALT 2/EORTC 08012 multicentrerandomised trial and update of systematic review. The Lancet. 2007;369(9577):1929–37.
Godehard F, et al. Phase II trial of a trimodality regimen for stage III non-small-cell lung cancer using chemotherapy as induction treatment with concurrent hyperfractionated chemoradiation with carboplatin and paclitaxel followed by subsequent resection: a single-center study. J Clin Oncol. 2010;28(6):942–8.
Steger V, et al. Surgery on unfavourable persistent N2/N3 non-small-cell lung cancer after trimodal therapy: do the results justify the risk? Interact Cardiovasc Thorac Surg. 2012;15(6):948–53.
Pöttgen C, et al. Prognostic model for long-term survival of locally advanced non-small-cell lung cancer patients after neoadjuvant radiochemotherapy and resection integrating clinical and histopathologic factors. BMC Cancer. 2015;15(1):363.
Waldemar S, et al. Pathologic complete response after induction therapy—the role of surgery in stage IIIA/B locally advanced non-small cell lung cancer. J Thorac Dis. 2018;10(5):2795.
Georgoulias V, et al. Platinum-basedandnon-platinum-basedchemotherapy in advancednon-small-celllungcancer: a randomisedmulticentretrial. TheLancet. 2001;357(9267):1478–84.
West H, et al. Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2019;20(7):924–37.
Jocelyne M, et al. Morbidity and mortality after neoadjuvant therapy for lung cancer: the risks of right pneumonectomy. The Ann Thoracic Surgery. 2001;72(4):1149–54.
Abby W, et al. Pneumonectomy is safe and effective for non-small cell lung cancer following induction therapy. J Thorac Dis. 2017;9(11):4447.
Shaikh T, Ruth K, Scott WJ, Burtness BA, Cohen SJ, Konski AA, Meyer JE. A longer interval between neoadjuvant therapy and surgery was also associated with higher pathological complete response rates in a study for esophageal carcinoma. Increased time from neoadjuvant chemoradiation to surgery is associated with higher pathologic complete response rates in esophageal cancer. The Ann Thorac Surg. 2015;99(1):270–6.
Kawayake H, et al. Non-small cell lung cancer with pathological complete response: predictive factors and surgical outcomes. Gen Thorac Cardiovasc Surg. 2019;67(9):773–81.
William WN Jr, et al. Computed tomography RECIST assessment of histopathologic response and prediction of survival in patients with resectable non–small-cell lung cancer after neoadjuvant chemotherapy. J Thorac Oncol. 2013;8(2):222–8.
Agrawal V, et al. Radiologic-pathologic correlation of response to chemoradiation in resectable locally advanced NSCLC. Lung Cancer. 2016;102:18.
Pöttgen C, et al. Value of 18F-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography in non–small-cell lung cancer for prediction of pathologic response and times to relapse after neoadjuvant chemoradiotherapy. Clin Cancer Res. 2006;12(1):97–106.
Cerfolio RJ, et al. Repeat FDG-PET after neoadjuvant therapy is a predictor of pathologic response in patients with non-small cell lung cancer. The Ann Thorac Oncol. 2004;78(6):1903–9.
Arnett AL, et al. FDG-PET parameters as predictors of pathologic response and nodal clearance in patients with stage III non-small cell lung cancer receiving neoadjuvant chemoradiation and surgery. Pract Radiat Oncol. 2017;7(6):e531–41.
Fukumoto K, et al. The role of 18 F-fluorodeoxyglucose positron emission tomography-computed tomography for predicting pathologic response after induction therapy for thymic epithelial tumors. World J Surg. 2017;41(7):1828–33.
Kittaka H, et al. Role of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography in predicting the pathologic response to preoperative chemoradiation therapy in patients with resectable T3 pancreatic cancer. World J Surg. 2013;37(1):169–78.
de Cabanyes Candela S, Detterbeck FC. A systematic review of restaging after induction therapy for stage IIIa lung cancer: prediction of pathologic stage. J Thorac Oncol. 2010;5(3):389–98.
Coroller TP, et al. Radiomic phenotype features predict pathological response in non-small cell lung cancer. Radiother Oncol. 2016;119(3):480–6.
Funding
There was no funding provided for this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declared that they have no confict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
İşgörücü, Ö., Citak, N. Survival analysis of pathological complete response of locally advanced lung cancer after neoadjuvant treatment. Gen Thorac Cardiovasc Surg 69, 1086–1095 (2021). https://doi.org/10.1007/s11748-020-01584-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-020-01584-z