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
{"title":"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","authors":"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","doi":"10.1016/j.cllc.2024.03.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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] <em>vs.</em> 6[5-8] days, <em>P</em> = .021), reduced postoperative comorbidities (21.0% <em>vs.</em> 37.1%, <em>P</em> = .048), and dissected less N1 lymph nodes (5[4-6] <em>vs.</em> 7[5-9], <em>P</em> = .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% <em>vs.</em> 73.73%, <em>P</em> = .640), overall survival (87.22% <em>vs.</em> 88.00%, <em>P</em> = .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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages 395-406.e5"},"PeriodicalIF":3.3000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424000421/pdfft?md5=a8b70f17746856a06c16c8317054ee5f&pid=1-s2.0-S1525730424000421-main.pdf","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"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\",\"doi\":\"10.1016/j.cllc.2024.03.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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] <em>vs.</em> 6[5-8] days, <em>P</em> = .021), reduced postoperative comorbidities (21.0% <em>vs.</em> 37.1%, <em>P</em> = .048), and dissected less N1 lymph nodes (5[4-6] <em>vs.</em> 7[5-9], <em>P</em> = .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% <em>vs.</em> 73.73%, <em>P</em> = .640), overall survival (87.22% <em>vs.</em> 88.00%, <em>P</em> = .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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>\",\"PeriodicalId\":10490,\"journal\":{\"name\":\"Clinical lung cancer\",\"volume\":\"25 5\",\"pages\":\"Pages 395-406.e5\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1525730424000421/pdfft?md5=a8b70f17746856a06c16c8317054ee5f&pid=1-s2.0-S1525730424000421-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical lung cancer\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1525730424000421\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical lung cancer","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1525730424000421","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
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
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.
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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