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Multicenter Study
. 2023 Dec;71(12):715-722.
doi: 10.1007/s11748-023-01942-7. Epub 2023 May 14.

Upfront surgery for N2 NSCLC: a large retrospective multicenter cohort study

Alessio Campisi  1 , Chiara Catelli  2 , Piotr Gabryel  3 , Riccardo Giovannetti  4 , Andrea Dell'Amore  2 , Mariusz Kasprzyk  3 , Cezary Piwkowski  3 , Maurizio Infante  4
Affiliations
Multicenter Study

Upfront surgery for N2 NSCLC: a large retrospective multicenter cohort study

Alessio Campisi et al. Gen Thorac Cardiovasc Surg. 2023 Dec.

Abstract

Background: The optimal sequence and combination of surgery, chemotherapy and radiotherapy in patients with N2 non-small cell lung cancer (NSCLC) remain undefined. The aim of our study was to compare two treatment options for N2 NSCLC-induction therapy with subsequent surgery versus upfront surgery with adjuvant treatment.

Methods: We retrospectively reviewed 405 patients with N2 disease in two centers, between January 2010 and December 2016. They were divided into two groups: the Induction Group, composed of patients who received neoadjuvant chemotherapy, and the Upfront surgery Group, composed of patients who underwent surgery as first-line therapy. Propensity score-matched (PSM) analysis was performed, and 52 patients were included in each group. Primary endpoints were: recurrence, overall survival (OS) and disease-free survival (DFS).

Results: After the PSM, no differences were observed in general characteristics, perioperative results, rates and severity of complications, and histopathology results. Seventeen patients (32.7%) of the induction group and 21 (40.4%) of the upfront surgery group had mediastinal lymph nodal involvement with skipping (p = 0.415). Recurrence rate was not different between the two groups (57.7% vs 50.0%, p = 0.478). No differences were observed in terms of OS (40.98 ± 35.78 vs 37.0 ± 40.69 months, p = 0.246) and DFS (29.67 ± 36.01 vs 27.96 ± 40.08 months, p = 0.697). The multivariable analysis identified the pT stage and skipping lymph node metastasis as independent predictive factors for OS.

Conclusions: Upfront surgery followed by adjuvant therapy does not appear inferior in terms of recurrence, OS and DFS, compared to induction chemotherapy with subsequent surgery.

Keywords: Induction therapy; Lung cancer; N2 disease; Upfront surgery.

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References

    1. Vansteenkiste J, Crinò L, Dooms C, et al. Panel Members. 2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Ann Oncol. 2014;25(8):1462–74. - DOI - PubMed
    1. Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: non-small cell lung cancer, version 2.2021. J Natl Compr Canc Netw. 2021;19(3):254–66. - DOI - PubMed
    1. Riquet M, Bagan P, Le Pimpec BF, et al. Completely resected non-small cell lung cancer: reconsidering prognostic value and significance of N2 metastases. Ann Thorac Surg. 2007;84(6):1818–24. - DOI - PubMed
    1. Amin MB, editor. AJCC cancer staging manual. 8th ed. Switzerland: Springer; 2017. p. 431–55.
    1. Bryan DS, Donington JS. The role of surgery in management of locally advanced non-small cell lung cancer. Curr Treat Options Oncol. 2019;20(4):27. - DOI - PubMed

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