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Multicenter Study
. 2024 Sep 1;10(9):1179-1186.
doi: 10.1001/jamaoncol.2024.2491.

Recurrence of Non-Small Cell Lung Cancer With Visceral Pleural Invasion: A Secondary Analysis of a Randomized Clinical Trial

Nasser Altorki  1 , Xiaofei Wang  2 , Bryce Damman  3 , David R Jones  4 , Dennis Wigle  5 , Jeffrey Port  1 , Massimo Conti  6 , Ahmad S Ashrafi  7 , Moishe Liberman  8 , Rodney Landreneau  9 , Kazuhiro Yasufuku  10 , Stephen Yang  11 , John D Mitchell  12 , Robert Keenan  13 , Thomas Bauer  14 , Daniel Miller  15 , David Kozono  16 , Jennifer Mentlick  3 , Everett Vokes  17 , Thomas E Stinchcombe  18
Affiliations
Multicenter Study

Recurrence of Non-Small Cell Lung Cancer With Visceral Pleural Invasion: A Secondary Analysis of a Randomized Clinical Trial

Nasser Altorki et al. JAMA Oncol. .

Erratum in

  • Error in Byline.
    [No authors listed] [No authors listed] JAMA Oncol. 2024 Nov 1;10(11):1598. doi: 10.1001/jamaoncol.2024.5097. JAMA Oncol. 2024. PMID: 39418063 Free PMC article. No abstract available.

Abstract

Importance: The randomized clinical trial Cancer and Leukemia Group B (CALGB) 140503 showed that for patients with clinically staged T1N0 non-small cell lung cancer (NSCLC; ≤2 cm), sublobar resections were associated with similar oncological outcomes to those after lobar resection. The association of the extent of parenchymal resection with recurrence and survival in patients with tumors pathologically upstaged to T2 based on visceral pleural invasion (VPI) is controversial.

Objective: To determine survival and recurrence rates in patients with small peripheral pT2 NSCLC (≤2 cm) that was treated by either lobar or sublobar resection in CALGB 140503.

Design, participants, and setting: CALGB 140503, a randomized multicenter noninferiority trial, included 697 patients with small peripheral NSCLC that was clinically staged as T1N0. Enrollment was from June 2007 through March 2017 at 83 participating institutions, and after a median follow-up of 7 years, the primary outcome of disease-free survival after sublobar resection was noninferior to that after lobar resection.

Intervention: Lobar or sublobar resection.

Main outcomes and measures: Survival end points were estimated by the Kaplan-Meier estimator. Hazard ratios and 95% CIs were estimated using stratified Cox proportional hazard models.

Results: Of 679 participants, 390 (57.4%) were female, and the median (range) age was 67.8 (37.8-89.7) years. Among 697 patients randomized, 566 (81.2%) had pT1 tumors (no VPI) and 113 (16.2%) had pT2 tumors (VPI). Five-year disease-free survival was 65.9% (95% CI, 61.9%-70.2%) in patients with pT1 compared with 53.3% (95% CI, 44.3%-64.1%) in patients with pT2 tumors (stratified log-rank: P = .02). Disease recurrence developed in 27.6% of patients with pT1 (locoregional only: 60 [10.8%]; distant only: 81 [14.6%]) and 41.6% of those with pT2 (locoregional only: 17 [15.0%]; distant only: 27 [23.9%]). Five-year recurrence-free survival was 73.1% (95% CI, 69.2%-77.1%) for pT1 tumors and 58.2% (95% CI, 49.2%-68.8%) for pT2 tumors (stratified log-rank: P = .01). There were no intergroup differences in disease-free or recurrence-free survival based on the extent of parenchymal resection.

Conclusions and relevance: The results of this secondary analysis suggest that compared with patients with tumors without VPI, patients who had tumors with VPI had worse disease-free and recurrence-free survival and a higher rate of local and distant disease recurrence. These high rates of recurrence were independent of the extent of parenchymal resection, and these data support the inclusion of these patients in adjuvant therapy trials.

Trial registration: ClinicalTrials.gov Identifier: NCT0049933.

Trial registration: ClinicalTrials.gov NCT00049933.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Altorki reported grants from AstraZeneca and Janssen Pharmaceuticals and research support from the National Cancer Institute and US Department of Defense outside the submitted work. Dr Jones reported advisory service for AstraZeneca and More Health, speaking fees from DAVA Oncology, and grants from Merck outside the submitted work. Dr Kozono reported personal fees from Genentech/Roche outside the submitted work. Dr Stinchcombe reported personal fees from Janssen, Daiichi Sankyo, AstraZeneca, Takeda, Eisai/H3 Biomedicine, G1 Therapeutics, Gilead Sciences, and Coherus Biosciences; research funding from AstraZeneca, Takeda, Seagen, Mirati Therapeutics, and Genentech/Roche (to institution); and data safety monitoring board service for Genentech/Roche, and GlaxoSmithKline outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Disease-Free Survival (DFS)
A, DFS in pT1 and pT2 tumors. B, DFS for pT1 and pT2 tumors based on the extent of parenchymal resection. C, DFS for pT1 and pT2 tumors 2 cm or smaller based on the extent of pulmonary resection. HR indicates hazard ratio.
Figure 2.
Figure 2.. Recurrence-Free Survival (RFS)
A, RFS for pT1 and pT2 tumors. B, RFS for pT1 and pT2 tumors by extent of parenchymal resection. HR indicates hazard ratio.
See this image and copyright information in PMC

Comment on

References

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