Abstract
Objective
Surgical treatment of locally advanced non–small cell lung cancer including single
or multilevel N2 remains a matter of debate. Several trials demonstrate that selected
patients benefit from surgery if R0 resection is achieved. We aimed to assess resectability
and outcome of patients with locally advanced clinical T3/T4 (American Joint Committee
on Cancer 8th edition) tumors after induction treatment followed by surgery in a pooled analysis
of 3 prospective multicenter trials.
Methods
A total of 197 patients with T3/T4 non–small cell lung cancer of 368 patients with
stage III non–small cell lung cancer enrolled in the Swiss Group for Clinical Cancer
Research 16/96, 16/00, 16/01 trials were treated with induction chemotherapy or chemoradiation
therapy followed by surgery, including extended resections. Univariable and multivariable
analyses were applied for analysis of outcome parameters.
Results
Patients’ median age was 60 years, and 67% were male. A total of 38 of 197 patients
were not resected for technical (81%) or medical (19%) reasons. A total of 159 resections
including 36 extended resections were performed with an 80% R0 and 13.2% pathological
complete response rate. The 30- and 90-day mortality were 3% and 7%, respectively,
without a difference for extended resections. Morbidity was 32% with the majority
(70%) of minor grading complications. The 3-, 5-, and 10-year overall survivals for
extended resections were 61% (95% confidence interval, 43-75), 44% (95% confidence
interval, 27-59), and 29.5% (95% confidence interval, 13-48), respectively. R0 resection
was associated with improved overall survival (hazard ratio, 0.41; P < .001), but pretreatment N2 extension (177/197) showed no impact on overall survival.
Conclusions
Surgery after induction treatment for advanced T3/T4 stage including single and multiple
pretreatment N2 disease resulted in 80% R0 resection rate and 7% 90-day mortality.
Favorable overall survival for extended and not extended resection was demonstrated
to be independent of pretreatment N status.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
CT (computed tomography), EFS (event-free survival), HR (hazard ratio), IQR (interquartile range), MPR (major pathologic response), MRI (magnetic resonance imaging), NCCN (National Comprehensive Cancer Network), NSCLC (non–small cell lung cancer), OS (overall survival), OR (odds ratio), pCR (pathological complete response), PET (positron emission tomography), SAKK (Swiss Group for Clinical Cancer Research)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 16, 2022
Accepted:
March 12,
2022
Received in revised form:
March 1,
2022
Received:
April 29,
2021
Footnotes
Clinical Trial Registry Number: SAKK 16/96: ClinicalTrials.gov, Number NCT00003231, SWS-SAKK-16/96; EU-97034. SAKK 16/00: ClinicalTrials.gov, Number NCT00030771, SWS-SAKK-16/00, EU-20138. SAKK 16/01: ClinicalTrials.gov, Number NCT00030810, SWS-SAKK-16/01; EU-20137. Ethics agreement with Institutional Review Board/Ethics Review Board numbers was given by each institution of the participating centers.
Identification
Copyright
© 2022 by The American Association for Thoracic Surgery
