Influence of adjuvant chemotherapy on survival for patients with completely resected high-risk stage IB NSCLC

Zi-Qing Shen; Kun-Peng Feng; Zi-Yao Fang; Tian Xia; Shu Pan; Cheng Ding; Chun Xu; Sheng Ju; Jun Chen; Chang Li; Jun Zhao

doi:10.1186/s13019-023-02457-1

Influence of adjuvant chemotherapy on survival for patients with completely resected high-risk stage IB NSCLC

J Cardiothorac Surg. 2024 Jan 2;19(1):1. doi: 10.1186/s13019-023-02457-1.

Authors

Zi-Qing Shen^#¹, Kun-Peng Feng^#¹, Zi-Yao Fang¹, Tian Xia¹, Shu Pan¹, Cheng Ding¹, Chun Xu¹, Sheng Ju¹, Jun Chen¹, Chang Li², Jun Zhao³

Affiliations

¹ Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
² Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China. cli@suda.edu.cn.
³ Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China. zhaojia0327@126.com.

^# Contributed equally.

Abstract

Background: The use of adjuvant chemotherapy (ACT) in completely resected stage IB NSCLC is still controversial. This study aims to investigate the efficacy of ACT in pathological stage IB non-small cell lung cancer (NSCLC) with high risk factors.

Methods: Patients with pT2aN0M0 stage IB NSCLC who underwent complete resection from 2013 to 2017 were retrospectively analyzed. Univariate and multivariable logistic regression analysis was used to assess potential independent risk factors associated with poor prognosis. To compare survival between patients who received ACT and those who did not.

Results: In univariate and multivariate analyses, adenocarcinomas with predominantly micropapillary (MIP) and solid patterns (SOL), poorly differentiated squamous cell carcinoma (SCC), number of lymph nodes dissected less than 16 and tumor size larger than 36 mm were identified as high-risk factors for recurrence. In patients with high risk factors for recurrence, ACT resulted in significantly longer DFS (HR, 0.4689, 95%CI, 1.193-3.818; p = 0.0108) and OS (HR, 0.4696, 95%CI, 0.6578-6.895; p = 0.2073), although OS failed to reach statistically significance. After propensity score matching (PSM), 67 pairs of patients were 1:1 matched in the two groups and all baseline characteristics were well balanced. The results also demonstrated that ACT was associated with improved DFS (HR, 0.4776, 95%CI, 0.9779-4.484; p = 0.0440) while OS was not significantly different (92.5% vs. 91.0%; HR, 0.6167, 95%CI, 0.1688-2.038; p = 0.7458). In patients with low-risk factors for recurrence, DFS (HR, 0.4831, 95%CI, 0.03025-7.715; p = 0.6068) and OS (HR, 0.969, 95%CI, 0.08364-11.21; p = 0.9794) was not significantly different between those who received ACT and those who did not.

Conclusion: In patients with completely resected stage IB NSCLC, ACT can improve survival in patients with high risk for recurrence. Further large multicenter studies are needed to confirm these findings.

Keywords: Adjuvant chemotherapy; Early stage; High risk; Non-small cell lung cancer.

MeSH terms

Carcinoma, Non-Small-Cell Lung* / drug therapy
Carcinoma, Non-Small-Cell Lung* / surgery
Chemotherapy, Adjuvant
Humans
Lung Neoplasms* / drug therapy
Lung Neoplasms* / surgery
Neoplasm Staging
Retrospective Studies

Abstract

MeSH terms

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