Agreement on Major Pathological Response in NSCLC Patients Receiving Neoadjuvant Chemotherapy

Abstract

The assessment of MPR was reproducible between observers. We confirmed that MPR is associated with OS and can serve as an independent prognostic factor in NSCLC patients undergoing neoadjuvant chemotherapy. Our data suggest that at least 3 slides should be read to accurately determine tumor response. Our results clearly demonstrate that MPR is a significant predictor of OS. Introduction: We have suggested that major pathologic response (MPR) could serve as a surrogate endpoint for survival and provide rapid means of comparing different neoadjuvant treatment regimens. Here, we confirm that MPR is predictive of long-term overall survival (OS) in patients with nonesmall-cell lung cancer (NSCLC) who underwent neoadjuvant chemotherapy and surgical resection, to assess agreement on MPR between 2 observers, and to determine the minimum number of slides needed to obtain an accurate determination of MPR. Patients and Methods:We identified 151 patients with NSCLC who had been treated with neoadjuvant chemotherapy followed by complete surgical resection from 2008 to 2012. Tissue specimens were retrospectively evaluated by 2 pathologists who had been blinded to patients' treatment and outcome. We assessed the relationships between MPR and OS, the levels of agreement between the pathologists, and determined the number of slides needed to obtain an accurate determination of MPR. Results: Our results reveal that MPR examined by either observer 1 (experienced) or by observer 2 (trained) was significantly predictive of long-term OS after neoadjuvant chemotherapy. MPR was associated with longterm OS in patients with NSCLC undergoing neoadjuvant chemotherapy on multivariable analysis (hazard ratio 2.68; P ¼ .01). The levels of agreement between 2 pathologists were high after direct in-person training by one pathologist or the other (R 2 ¼ 0.994). Our data suggest that at least 3 slides should be read to accurately determine MPR. Conclusions: MPR is significantly predictive of long-term OS in neoadjuvant chemotherapyetreated patients with NSCLC. MPR may serve as a surrogate endpoint for evaluating novel chemotherapies and immunotherapy response in biomarker-driven translational clinical trials.

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

“…Further comparison of the postoperative pathological remission of the two groups showed that the immunotherapy group had a higher MPR. Some research suggests that the MPR may be related to the long-term survival of patients and that it will become an indicator of the survival time of patients in the future, but more research is required to confirm this (33,34).…”

A mRNA-miRNA-lncRNA regulatory network related to potential pathogenesis and prognostic markers of Non- small cell lung cancer

“…So, the 5-year survival rate of patients is very low 8 . The current surgical treatment, chemotherapy and other means can't signi cantly improve the survival rate of patients, but greatly reduce the quality of life of patients at the same time 9 . It brings heavy economic burden to the patients' families, which makes countless families fragmented.…”

Neoadjuvant immunotherapy for non–small cell lung cancer: State of the art

“…Although pCR after neoadjuvant therapy may be an effective alternative measurement for OS [77, 78], pCR is rarely used as the primary endpoint in clinical trials [52, 53]. MPR, defined as ≤10% of viable tumor cells in a surgically resected specimen, is more commonly used in clinical trials because it has a higher incidence than pCR [79]. Many studies have reported that MPR is predictive of the OS of patients with early‐stage NSCLC [77, 80, 81].…”