Perioperative safety and feasibility outcomes of stage IIIA-N2 non-small cell lung cancer following neoadjuvant immunotherapy or neoadjuvant chemotherapy: a retrospective study

Zhangfeng Huang; Zhe Wu; Yi Qin; Yandong Zhao; Yunpeng Xuan; Tong Qiu; Ao Liu; Yanting Dong; Wenhao Su; Wenxing Du; Tianxiang Yun; Lingjie Wang; Dahai Liu; Lili Sun; Wenjie Jiao

doi:10.21037/atm-21-1141

Perioperative safety and feasibility outcomes of stage IIIA-N2 non-small cell lung cancer following neoadjuvant immunotherapy or neoadjuvant chemotherapy: a retrospective study

Ann Transl Med. 2021 Apr;9(8):685. doi: 10.21037/atm-21-1141.

Authors

Zhangfeng Huang¹, Zhe Wu¹, Yi Qin¹, Yandong Zhao¹, Yunpeng Xuan¹, Tong Qiu¹, Ao Liu¹, Yanting Dong¹, Wenhao Su¹, Wenxing Du¹, Tianxiang Yun¹, Lingjie Wang¹, Dahai Liu¹, Lili Sun², Wenjie Jiao¹

Affiliations

¹ Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
² Department of Ultrasound, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.

Abstract

Background: We sought to determine the perioperative safety and feasibility outcomes of stage IIIA (N2) non-small cell lung cancer (NSCLC) following neoadjuvant immunotherapy or neoadjuvant chemotherapy.

Methods: The clinical details of patients who attended the Affiliated Hospital of Qingdao University between January 2019 and December 2020 were retrospectively evaluated. Eligible patients had pathologically proven stage IIIA (N2) NSCLC and were randomly prescribed neoadjuvant therapy. Those in the neoadjuvant immunotherapy group received two cycles of nivolumab (3 mg/kg) and those in the control group received neoadjuvant chemotherapy (1,000 mg/m² gemcitabine and 80 mg/m² cisplatin). All patients were scheduled to undergo surgery. The primary endpoint was the risk of major complications within 30 days of surgery and the secondary endpoints were interval to surgery and 30-day mortality.

Results: A total of 107 eligible patients were evaluated of whom 25 were allocated to the neoadjuvant immunotherapy group and 82 to the neoadjuvant chemotherapy group. The median interval to surgery was similar in the two groups at 29.2 days [95% confidence interval (CI), 27.1 to 31.4 days] in the immunotherapy group and 28.7 days (95% CI, 27.6 to 29.8 days) in the chemotherapy group (P=0.656). While treatment-related adverse events were reported in most patients, all 25 patients completed two cycles of neoadjuvant immunotherapy and 80 of 82 patients completed two cycles of neoadjuvant chemotherapy, although one patient in the latter group died within 30 days of surgery. There was no statistically significant difference between the groups in the probability of grade 3 or higher postoperative complications within 30 days after surgery (P=0.757).

Conclusions: Most patients achieved the primary and secondary endpoints of the study. However, the major pathological response (MPR) showed statistically significant differences between the neoadjuvant immunotherapy and neoadjuvant chemotherapy groups.

Keywords: IIIA-N2 disease; Non-small cell lung cancer (NSCLC); neoadjuvant therapy; perioperative; safety and feasibility.