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Review
. 2021 Jan;10(1):581-589.
doi: 10.21037/tlcr-20-515.

Prognostic factors in potentially resectable stage III non-small cell lung cancer receiving neoadjuvant treatment-a narrative review

Virginia Calvo  1 , Carlos Aliaga  2 , Carlos Carracedo  2 , Mariano Provencio  1
Affiliations
Review

Prognostic factors in potentially resectable stage III non-small cell lung cancer receiving neoadjuvant treatment-a narrative review

Virginia Calvo et al. Transl Lung Cancer Res. 2021 Jan.

Abstract

Lung cancer is the leading cause of cancer-related death in worldwide. The most important treatment for patients with stage I and II non-small cell lung cancer (NSCLC) is surgery. Resected stage II and III NSCLC patients should be offered adjuvant chemotherapy and in patients with resected stage IB disease and with a primary tumor >4 cm this treatment could be considered. The treatment of resectable locally advanced NSCLC should be evaluated within an experienced multidisciplinary team. Neoadjuvant chemotherapy can be considered in patients with resectable disease and clear candidates for complementary chemotherapy. Neoadjuvant chemotherapy has similar impact on overall survival (OS) than adjuvant chemotherapy, however postoperative chemotherapy has more evidence-based support. Immunotherapy is being studied in early and locally advanced NSCLC as a neoadjuvant or adjuvant treatment. Different prognostic factors have been described in patients with stage III who have received neoadjuvant treatment, which we intend to review in this article.

Keywords: Carcinoma; neoadjuvant therapy; non-small cell lung; prognostic factors.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-515). The series “Multimodal management of locally advanced N2 non-small cell lung cancer” was commissioned by the editorial office without any funding or sponsorship. MP served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Translational Lung Cancer Research from Sep 2019 to Sep 2021. VC reports personal fees: Roche, BMS, MSD, AstraZeneca, Boehringer. MP reports honoraria as speaker and consultant on advisory boards from: Roche, BMS, MSD, Takeda and Lilly. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
OS in patients with and without MPR (41). OS, overall survival; MPR, major pathologic response.
Figure 2
Figure 2
How to evaluate the resected surgical specimen of a patient treated with neoadjuvant chemotherapy (48).
Figure 3
Figure 3
Histologic features of pathologic response to neoadjuvant ICI (anti-PD-1) in NSCLC. Post-treatment NSCLC specimens with MPR to therapy showed a distinct pattern of immune-mediated tumor regression (54). Hematoxylin and eosin-stained slides. ICI, immune checkpoint inhibitor; NSCLC, non-small cell lung cancer; MPR, major pathologic response.
Figure 4
Figure 4
Proposal for reproducible, quantitative irPRC. %irRVT is assessed by dividing the total area involved by tumor of RVT (circled in blue) by the total tumor bed area ×100. The total tumor bed area (circled in green) is composed of the regression bed area + RVT area + areas of necrosis (54). irPRC, immune-related pathologic response criteria; RVT, residual viable tumor.
See this image and copyright information in PMC

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