Survival Outcomes of Neoadjuvant Therapy Followed by Sleeve Lobectomy in Non-Small Cell Lung Cancer.

Abstract

Background: This study was carried out to evaluate the impact of neoadjuvant therapy on long-term survival of patients with non-small cell lung cancer undergoing sleeve lobectomy.

Methods: A total of 613 patients were retrospectively analyzed, including 124 who received neoadjuvant therapy. A 1:2 propensity score matching method was adopted to create a balanced cohort including 110 with neoadjuvant therapy and 169 without neoadjuvant therapy. Survival was estimated by the Kaplan-Meier method and compared with the log-rank test and Cox proportional hazards models.

Results: Neoadjuvant therapy was associated with improved 3-year disease-free survival (DFS; 73.6% vs 54.4%; P < .001) and overall survival (OS; 80.9% vs 63.9%; P = .002) compared with patients without neoadjuvant therapy. Moreover, neoadjuvant chemoimmunotherapy significantly improved 3-year DFS (85.3% vs 54.4%; P = .001) and OS (88.2% vs 63.9%; P = .006), whereas chemotherapy alone did not show a significant effect. Multivariable Cox regression analysis revealed neoadjuvant therapy to be an independent predictor of improved DFS and OS, whereas pathologic N2 stage was independently associated with poorer DFS and OS. Furthermore, subgroup analysis in the neoadjuvant arm revealed that pathologic N2 stage is an independent risk factor for DFS (hazard ratio, 3.830; 95% CI, 1.687-8.694; P = .001), and achieving major pathologic response is an independent predictor for better OS (hazard ratio, 0.120; 95% CI, 0.015-0.933; P = .043).

Conclusions: Neoadjuvant therapy before sleeve lobectomy significantly increased DFS and OS in locally advanced non-small cell lung cancer. Sleeve lobectomy is advisable after neoadjuvant therapy, especially following chemoimmunotherapy.