Extended resection for potentially operable stage III NSCLC patients after neoadjuvant treatment

Structured Abstract

Objective

Surgical treatment of locally advanced NSCLC 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 (AJCC 8^th-edition) tumors after induction treatment followed by surgery in a pooled analysis of three prospective multicenter trials.

Methods

197 patients with T3/T4 NSCLC out of 368 stage III-NSCLC patients enrolled in SAKK 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

Median age was 60 years with 67% male patients. 38/197 patients were not resected for technical (81%) or medical (19%) reasons. 159 resections including 36 extended resections were performed with an 80% R0 and 13.2% pathological complete response-rate. 30- and 90-day mortality was 3% and 7%, respectively, without difference for extended resections. Morbidity was 32% with majority (70%) of minor grading complications. 3-, 5-, and 10-year overall survival (OS) even for extended resections was 61% [95%CI: 43-75], 44% [95%CI: 27-59], and 29.5% [95%CI: 13-48]. R0 resection was associated with improved OS ([HR, 0.41], P<0.001), but pretreatment N2-extension (177/197) revealed no impact on OS.

Conclusions

Surgery after neoadjuvant 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 independent from pretreatment N-status.