Major Pathologic Response after Induction Therapy Has a Long-Term Impact on Survival and Tumor Recurrence in Stage IIIA/B Locally Advanced NSCLC

Abstract

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.

Neoadjuvant PD‐1 inhibitor combines with chemotherapy versus neoadjuvant chemotherapy in resectable squamous cell carcinoma of the lung

“…Studies have demonstrated the correlation between complete pathological response and overall survival, 13–16 and proved the validity of the MPR as a surrogate of survival 17–20 . In this study, the pathological response is different between the IM and C groups ( p = 0.098; Table 2) and the degree of residual viable cells is 15.31 ± 15.75% versus 36.72 ± 32.49% ( p = 0.058; Figure 1 and Table 2).…”

“…Studies have demonstrated the correlation between complete pathological response and overall survival, [13][14][15][16] and proved the validity of the MPR as a surrogate of survival. [17][18][19][20] In this study, the pathological response is different between the IM and C groups (p = 0.098; Table 2) and the degree of residual viable cells is 15.31 AE 15.75% versus 36.72 AE 32.49% (p = 0.058; Figure 1 and Table 2). However, the rate of the MPR in the chemotherapy-only group was 38.46%, which is much higher than that previously reported (around 26%), 21 while the rate of the MPR in the IM group reached 50%, the same as reported by Shu et al 4 and Impower-030.…”

Real-World Effectiveness and Prognostic Factors Analysis of Stages I–III Non-Small Cell Lung Cancer Following Neoadjuvant Chemo-Immunotherapy or Neoadjuvant Chemotherapy

“…In multivariate analysis, pathological remission could improve DFS, which was also a common view supported by previous studies. 20,[24][25][26] As reported in Table 3, a 2.93 times higher relative risk of disease recurrence or metastasis (95% CI: 1.278-6.719, P = 0.011) was estimated in the Cox regression analysis for patients with non-MPR after surgery. Specifically, even in the pCR + MPR group, there is still the potential for recurrence and metastasis.…”

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).…”