{"title":"Conversion Surgery for Initially Unresectable Stage Ⅲ Nonsmall Cell Lung Cancer After Induction Treatment of Immunochemotherapy: A Multicenter Study.","authors":"Mingliang Wang, Xiaojun Wang, Ran Yang, Mingfei Geng, Songlin Zhang, Zebo Yang, Quanfu Huang, Sihua Wang, Shuangbing Xu, Ke Jiang, Yongde Liao","doi":"10.1016/j.cllc.2024.11.005","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Immuno-chemotherapy has demonstrated significant anti-tumor effects in patients with resectable nonsmall cell lung cancer (NSCLC). Additionally, for patients initially diagnosed with unresectable stage III NSCLC, induction immuno-chemotherapy may achieve tumor downstaging, enabling conversion to resectable disease allowing for by R0 resection. This study aimed to assess the effectiveness and safety of induction immuno-chemotherapy followed by conversion surgery in unresectable stage III NSCLC.</p><p><strong>Patients and methods: </strong>A total of 113 patients with unresectable stage Ⅲ NSCLC who received induction immuno-chemotherapy at three institutions in China from March 2019 to April 2022 were retrospectively identified. After 2-4 cycles of immuno-chemotherapy, a multisiciplinary team (MDT) reassessed the tumor response and resectability in each case. Surgical resection was performed for patients who achieved tumor downstaging to resectable disease. Surgical and oncological outcomes of the patients were analyzed.</p><p><strong>Results: </strong>Of the 113 patients treated with immuno-chemotherapy, 79 (69.9%) achieved conversion to resectable state and underwent surgery. Surgical procedures included lobectomy in 55 (69.6%) patients, sleeve lobectomy in 14 (17.7%) patients, bilobectomy in 6 (7.6%) patients, and pneumonectomy in 4 (5.1%) patients, achieving an R0 resection rate of 98.7% (78/79). No surgical-related 30-day or 90-day mortalities were recorded, although 17 patients (21.5%) experienced postoperative complications. In terms of pathological response, 44 (55.7%) patients achieved major pathologic response and 25 (31.6%) patients achieved complete pathologic response. Median progression-free survival (PFS) and overall survival (OS) was not reached. The 12- and 24-month PFS rates were 82.3% and 72.2%, while OS rates were 94.9% and 84.5%, respectively.</p><p><strong>Conclusion: </strong>Conversion surgery following immuno-chemotherapy is feasible and safe, yielding promising pathological responses and favorable survival outcomes for patients with unresectable stage III NSCLC.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical lung cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cllc.2024.11.005","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Immuno-chemotherapy has demonstrated significant anti-tumor effects in patients with resectable nonsmall cell lung cancer (NSCLC). Additionally, for patients initially diagnosed with unresectable stage III NSCLC, induction immuno-chemotherapy may achieve tumor downstaging, enabling conversion to resectable disease allowing for by R0 resection. This study aimed to assess the effectiveness and safety of induction immuno-chemotherapy followed by conversion surgery in unresectable stage III NSCLC.
Patients and methods: A total of 113 patients with unresectable stage Ⅲ NSCLC who received induction immuno-chemotherapy at three institutions in China from March 2019 to April 2022 were retrospectively identified. After 2-4 cycles of immuno-chemotherapy, a multisiciplinary team (MDT) reassessed the tumor response and resectability in each case. Surgical resection was performed for patients who achieved tumor downstaging to resectable disease. Surgical and oncological outcomes of the patients were analyzed.
Results: Of the 113 patients treated with immuno-chemotherapy, 79 (69.9%) achieved conversion to resectable state and underwent surgery. Surgical procedures included lobectomy in 55 (69.6%) patients, sleeve lobectomy in 14 (17.7%) patients, bilobectomy in 6 (7.6%) patients, and pneumonectomy in 4 (5.1%) patients, achieving an R0 resection rate of 98.7% (78/79). No surgical-related 30-day or 90-day mortalities were recorded, although 17 patients (21.5%) experienced postoperative complications. In terms of pathological response, 44 (55.7%) patients achieved major pathologic response and 25 (31.6%) patients achieved complete pathologic response. Median progression-free survival (PFS) and overall survival (OS) was not reached. The 12- and 24-month PFS rates were 82.3% and 72.2%, while OS rates were 94.9% and 84.5%, respectively.
Conclusion: Conversion surgery following immuno-chemotherapy is feasible and safe, yielding promising pathological responses and favorable survival outcomes for patients with unresectable stage III NSCLC.
期刊介绍：
Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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