Initial single-institutional experience with salvage surgery for stage IV non-small-cell lung cancer

Abstract

The purpose of this study was to assess surgical outcomes of salvage surgery for clinical stage IV non-small-cell lung cancer. A total of 14 patients who underwent lung resection following systemic therapy between 2010 and 2022 were included in this study. Systemic therapy prior to surgery included agents including epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in eight patients and non-TKI agents in six (chemotherapy alone: four, chemotherapy plus immune checkpoint inhibitors: two). During a median follow-up of 5.2 years, the EGFR-TKI group showed a favourable 5-year overall survival of 83%; however, it was due to treatment after relapse, and there were no 4-year relapse-free survivors. The non-EGFR-TKI group showed a 5-year relapse-free survival of 33%, and 2 patients have survived more than 3 years without any relapse and further treatment. When considering the role of surgery in multimodal treatment for initial c-stage IV non-small-cell lung cancer, salvage surgery following non-TKI therapy (chemotherapy with or without immune checkpoint inhibitor) can be regarded as genuine salvage surgery.

Keywords: cytotoxic agents; immune checkpoint inhibitors; non-small cell lung cancer; salvage surgery; stage IV; systemic therapy; tyrosine kinase inhibitor.

Figure 1:

(A) Overall and recurrence-free survival (OS and RFS) after salvage surgery for patients who received EGFR-TKI preoperatively (EGFR-TKI group). The 5-year OS was favourable (83%); however, RFS was significantly worse than OS (P = 0.018, log-rank test). There were no 4-year RFS. (B) OS and RFS after salvage surgery for the non-EGFR-TKI group. The 5-year OS and RFS are 50% and 33%, respectively, which is not statistically different (P = 0.25).