Major Pathologic Response after Induction Therapy Has a Long-Term Impact on Survival and Tumor Recurrence in Stage IIIA/B Locally Advanced NSCLC
Background Major pathologic response (MPR) determines favorable outcome in locally advanced non-small cell lung cancer after induction therapy (IT) followed by lung resection. The aim of this retrospective study was to identify the prognostic relevance of MPR in long-term interval.
Methods In 55 patients, the survival rate according to MPR and non-MPR was estimated by Kaplan–Meier method and compared using log-rank, Breslow, and Tarone–Ware tests.
Results The IT included chemoradiation with 50.4 Gy (range: 45–56.4 Gy) combined with platinum-based chemotherapy in 52 patients (94.5%) and platinum-based chemotherapy in 3 patients (5.5%). Perioperative morbidity and 30-day mortality were 36 and 3.6%, respectively. The estimated 5-year postoperative and progressive-free survivals were statistically significantly improved in MPR versus non-MPR with 53.5 versus 18% and 49.4 versus 18.5%, respectively. According to the log-rank, Breslow, and Tarone–Ware tests, the MPR demonstrates prognostic significance in early, long-term, and whole postoperative interval.
Conclusion MPR is associated with a robust correlation to long-term postoperative and recurrence-free survival improvement, and can potentially simplify the multidisciplinary debate and allow further stratification of adjuvant treatment in multimodality therapy.
Keywordsmajor pathologic response - locally advanced non-small cell lung cancer - induction therapy - stage III
Eingereicht: 01. Oktober 2018
Angenommen: 14. Januar 2019
26. Februar 2019 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
- 1 De Ruysscher D, Vansteenkiste J, Belderbos J, Decaluwé H, Dingemans AM. The optimal local treatment of stage IIIA-N2 NSCLC: is the issue finally settled?. J Thorac Oncol 2016; 11 (03) 284-286
- 2 van Meerbeeck JP. The controversial role of surgery in stage III NSCLC. Lancet Oncol 2008; 9 (07) 607-608
- 3 Mirimanoff RO. Neoadjuvant chemoradiotherapy followed by surgery for stage IIIa and IIIb non-small-cell lung cancer (NSCLC): is it still justified?. Linchuang Zhongliuxue Zazhi 2015; 4 (04) 49-57
- 4 Lococo F, Cesario A, Margaritora S. et al. Long-term results in patients with pathological complete response after induction radiochemotherapy followed by surgery for locally advanced non-small-cell lung cancer. Eur J Cardiothorac Surg 2013; 43 (03) e71-e81
- 5 Pataer A, Kalhor N, Correa AM. et al; University of Texas M. D. Anderson Lung Cancer Collaborative Research Group. Histopathologic response criteria predict survival of patients with resected lung cancer after neoadjuvant chemotherapy. J Thorac Oncol 2012; 7 (05) 825-832
- 6 Hellmann MD, Chaft JE, William Jr WN. et al; University of Texas MD Anderson Lung Cancer Collaborative Group. Pathological response after neoadjuvant chemotherapy in resectable non-small-cell lung cancers: proposal for the use of major pathological response as a surrogate endpoint. Lancet Oncol 2014; 15 (01) e42-e50
- 7 Cascone T, Gold KA, Swisher SG. et al. Induction cisplatin docetaxel followed by surgery and erlotinib in non-small cell lung cancer. Ann Thorac Surg 2018; 105 (02) 418-424
- 8 Eisenhauer EA, Therasse P, Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45 (02) 228-247
- 9 Junker K, Thomas M, Schulmann K, Klinke F, Bosse U, Müller KM. Tumour regression in non-small-cell lung cancer following neoadjuvant therapy. Histological assessment. J Cancer Res Clin Oncol 1997; 123 (09) 469-477
- 10 Junker K. Tumour regression in non-small-cell lung cancer following neoadjuvant therapy, a significant prognostic factor. J Cancer Res Clin Oncol 1998; 124: 283-284
- 11 Goldstraw P, Chansky K, Crowley J. et al; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions, International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee Advisory Boards and Participating Institutions. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11 (01) 39-51
- 12 Blumenthal GM, Bunn Jr PA, Chaft JE. et al. Current status and future perspectives on neo-adjuvant therapy in lung cancer. J Thorac Oncol 2018; 13 (12) 1818-1831
- 13 Crabtree TD, Sharma A. Is there any role for positron emission tomography-computed tomography after induction therapy for locally advanced non-small cell lung cancer?. J Thorac Cardiovasc Surg 2016; 151 (04) 911-912
- 14 Kappers I, van Sandick JW, Burgers JA. et al. Results of combined modality treatment in patients with non-small-cell lung cancer of the superior sulcus and the rationale for surgical resection. Eur J Cardiothorac Surg 2009; 36 (04) 741-746
- 15 Nason KS. Is there a role for postinduction positron emission tomography and computed tomography with fludeoxyglucose F 18? A call for standardization. J Thorac Cardiovasc Surg 2016; 151 (04) 980-981
- 16 Schreiner W, Gavrychenkova S, Dudek W. et al. Pathologic complete response after induction therapy-the role of surgery in stage IIIA/B locally advanced non-small cell lung cancer. J Thorac Dis 2018; 10 (05) 2795-2803
- 17 Pöttgen C, Stuschke M, Graupner B. et al. Prognostic model for long-term survival of locally advanced non-small-cell lung cancer patients after neoadjuvant radiochemotherapy and resection integrating clinical and histopathologic factors. BMC Cancer 2015; 15: 363
- 18 Massard G, Kessler R, Wihlm JM. Improved selection of winners: a working hypothesis for neoadjuvant chemotherapy. Ann Thorac Surg 1998; 66 (01) 300-301
- 19 Cerfolio RJ, Maniscalco L, Bryant AS. The treatment of patients with stage IIIA non-small cell lung cancer from N2 disease: who returns to the surgical arena and who survives. Ann Thorac Surg 2008; 86 (03) 912-920 , discussion 912–920
- 20 Isobe K, Hata Y, Sakaguchi S. et al. Pathological response and prognosis of stage III non-small cell lung cancer patients treated with induction chemoradiation. Asia Pac J Clin Oncol 2012; 8 (03) 260-266
- 21 Schreiner W, Dudek W, Lettmaier S, Gavrychenkova S, Rieker R, Fietkau R, Sirbu H. Neoadjuvant radiochemotherapy followed by curative resection in patients with advanced non-small cell lung cancer in stage IIIA/IIIB: prognostic factors and results. Zentralbl Chir 2016; 141: 323-329