Induction chemoimmunotherapy with surgery versus concurrent chemoradiation followed by immunotherapy for stage III-N2 non-small cell lung cancer

Arvind Kumar; Deepti Srinivasan; Alexandra L Potter; Camille Mathey-Andrews; Michael Lanuti; Linda W Martin; Chi-Fu Jeffrey Yang

doi:10.1016/j.jtcvs.2023.09.029

Induction chemoimmunotherapy with surgery versus concurrent chemoradiation followed by immunotherapy for stage III-N2 non-small cell lung cancer

J Thorac Cardiovasc Surg. 2024 Jun;167(6):1895-1905.e2. doi: 10.1016/j.jtcvs.2023.09.029. Epub 2023 Sep 16.

Authors

Arvind Kumar¹, Deepti Srinivasan², Alexandra L Potter², Camille Mathey-Andrews², Michael Lanuti², Linda W Martin³, Chi-Fu Jeffrey Yang⁴

Affiliations

¹ Icahn School of Medicine at Mount Sinai, New York, NY.
² Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
³ Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
⁴ Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass. Electronic address: cjyang@mgh.harvard.edu.

PMID: 37722622
DOI: 10.1016/j.jtcvs.2023.09.029

Abstract

Objective: Despite the growing relevance of immunotherapy for non-small cell lung cancer (NSCLC), there is limited consensus on the optimal treatment strategy for locally advanced NSCLC. This study evaluated the overall survival of patients with stage III-N2 NSCLC undergoing induction chemoimmunotherapy with surgery (CT/IO+Surgery) and definitive concurrent chemoradiation followed by immunotherapy (cCRT+IO).

Methods: Patients with cT1-3, N2, M0 NSCLC in the National Cancer Database (2013 to 2019) were included and stratified by treatment regimen: CT/IO+Surgery or cCRT+IO. Overall survival was evaluated using Kaplan-Meier analysis, Cox proportional hazards modeling, and propensity score matching on 10 prognostic variables.

Results: Of the 3382 patients who met the study eligibility criteria, 3289 (97.3%) received cCRT+IO and 93 (2.8%) received CT/IO+Surgery. The 3-year overall survival of the entire cohort was 58.2% (95% CI, 56.2% to 60.1%). Multivariable-adjusted Cox proportional hazards modeling demonstrated better survival after CT/IO+Surgery than after cCRT+IO (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.32 to 0.84; P = .007). In a 3:1 variable ratio propensity score-matched analysis of 223 patients who received cCRT+IO and 76 patients who received CT/IO+Surgery, 3-year overall survival was 63.2% (95% CI, 55.9% to 70.2%) after cCRT+IO and 77.2% (95% CI, 64.6% to 85.7%) after CT/IO+Surgery (P = .029).

Conclusions: In this national analysis, multimodal treatment including immunotherapy was associated with a 3-year overall survival rate of 58.2% for all patients with stage III-N2 NSCLC and 77.2% for patients who underwent chemoimmunotherapy followed by surgery. These results should be considered hypothesis-generating and demonstrate the importance of developing a randomized trial to evaluate the role of surgery versus chemoradiation for locally advanced NSCLC in the modern immunotherapy era.

Keywords: immunotherapy; locally advanced NSCLC; multimodal treatment; non–small cell lung cancer; thoracic surgery.

Publication types

Comparative Study

MeSH terms

Aged
Carcinoma, Non-Small-Cell Lung* / immunology
Carcinoma, Non-Small-Cell Lung* / mortality
Carcinoma, Non-Small-Cell Lung* / pathology
Carcinoma, Non-Small-Cell Lung* / therapy
Chemoradiotherapy* / mortality
Databases, Factual
Female
Humans
Immunotherapy / methods
Immunotherapy / mortality
Induction Chemotherapy / mortality
Lung Neoplasms* / immunology
Lung Neoplasms* / mortality
Lung Neoplasms* / pathology
Lung Neoplasms* / therapy
Male
Middle Aged
Neoplasm Staging*
Pneumonectomy* / adverse effects
Pneumonectomy* / mortality
Retrospective Studies
Treatment Outcome