Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Following Neoadjuvant Immunochemotherapy in Resectable Stage III Non-Small Cell Lung Cancer Among Chinese Populations: A Multi-Center Retrospective Cohort Study

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
Hanbo Pan , Hang Chen , Weicheng Kong , Junwei Ning , Zhen Ge , Yu Tian , Ningyuan Zou , Hongda Zhu , Jiaqi Zhang , Yixing Tao , Zenan Gu , Min Zheng , Guomo Ruan , Long Jiang , Ziming Li , Jia Huang , Chengwei Zhou , Guodong Xu , Qingquan Luo
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Abstract

Background

Immune checkpoint inhibitors have revolutionized non-small cell lung cancer (NSCLC) treatment but may pose greater technical challenges for surgery. This study aims to assess the feasibility and oncological effectiveness of video-assisted thoracoscopic surgery (VATS) for resectable stage III NSCLC after neoadjuvant immunochemotherapy.

Methods

Initial stage IIIA-IIIB NSCLC patients with neoadjuvant immunochemotherapy undergoing either VATS or open lobectomy at 6 medical centers during 2019-2023 were retrospectively identified. Perioperative outcomes and 2-year survival was analyzed. Propensity-score matching (PSM) was employed to balance patient baseline characteristics.

Results

Among the total 143 patients, PSM yielded 62 cases each for VATS and OPEN groups. Induction-related adverse events were comparable between the 2 groups. VATS showed a 14.5% conversion rate. Notably, VATS decreased numeric rating scales for postoperative pain, shortened chest tube duration (5[4-7] vs. 6[5-8] days, P = .021), reduced postoperative comorbidities (21.0% vs. 37.1%, P = .048), and dissected less N1 lymph nodes (5[4-6] vs. 7[5-9], P = .005) compared with thoracotomy. Even when converted, VATS achieves perioperative outcomes equivalent to thoracotomy. Additionally, over a median follow-up of 29.5 months, VATS and thoracotomy demonstrated comparable 2-year recurrence-free survival (77.20% vs. 73.73%, P = .640), overall survival (87.22% vs. 88.00%, P = .738), cumulative incidences of cancer-related death, and recurrence patterns. Subsequent subgroup comparisons and multivariate Cox analysis likewise revealed no statistical difference between VATS and thoracotomy.

Conclusion

VATS is a viable and effective option for resectable stage III NSCLC patients following neoadjuvant immunochemotherapy, leading to decreased surgical-related pain, earlier chest tube removal, reduced postoperative complications, and similar survival outcomes compared to thoracotomy.

Abstract Image

视频辅助胸腔镜手术与新辅助免疫化疗后胸廓切开术治疗中国人群中可切除的 III 期非小细胞肺癌:多中心回顾性队列研究
免疫检查点抑制剂彻底改变了非小细胞肺癌(NSCLC)的治疗,但可能会给手术带来更大的技术挑战。本研究旨在评估视频辅助胸腔镜手术(VATS)治疗新辅助免疫化疗后可切除的III期NSCLC的可行性和肿瘤学效果。回顾性地确定了2019-2023年间在6个医疗中心接受VATS或开胸肺叶切除术的新辅助免疫化疗的IIIA-IIIB期NSCLC初治患者。分析了围手术期结果和2年生存率。采用倾向分数匹配(PSM)来平衡患者的基线特征。在总共143名患者中,PSM得出VATS组和OPEN组各62例。两组患者的诱导相关不良事件相当。VATS 的转换率为 14.5%。值得注意的是,与开胸手术相比,VATS 减少了术后疼痛的数字评分量表,缩短了胸管持续时间(5[4-7] 6[5-8] 天,= .021),减少了术后并发症(21.0% 37.1%,= .048),切除的 N1 淋巴结较少(5[4-6] 7[5-9], = .005)。即使进行转换,VATS 的围手术期结果也与开胸手术相当。此外,在中位随访 29.5 个月期间,VATS 和开胸手术的 2 年无复发生存率(77.20% 73.73%,= .640)、总生存率(87.22% 88.00%,= .738)、癌症相关死亡累积发生率和复发模式均相当。随后的亚组比较和多变量考克斯分析同样显示,VATS 和开胸手术之间没有统计学差异。对于接受新辅助免疫化疗的可切除 III 期 NSCLC 患者来说,VATS 是一种可行且有效的选择,与开胸手术相比,VATS 可减少手术相关疼痛,提前拔除胸管,减少术后并发症,并获得相似的生存结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.20
自引率
4.30%
发文量
567
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