Neo-adjuvant chemotherapy plus immunotherapy in resectable N1/N2 NSCLC

Chengli Du; Yunhao Chen; Yuwei Zhou; Difang Zheng; Jiangang Zhao; Jie Tang; Yihe Wu; Zhengliang Tu

doi:10.1186/s12885-023-11745-x

Neo-adjuvant chemotherapy plus immunotherapy in resectable N1/N2 NSCLC

BMC Cancer. 2023 Dec 21;23(1):1260. doi: 10.1186/s12885-023-11745-x.

Authors

Chengli Du¹, Yunhao Chen¹, Yuwei Zhou¹, Difang Zheng¹, Jiangang Zhao¹, Jie Tang¹, Yihe Wu¹, Zhengliang Tu²

Affiliations

¹ Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China.
² Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China. tuzhl@sina.com.

Abstract

Background: Locally advanced non-small cell lung cancer (NSCLC) with N1/N2 lymph node metastasis is challenging with poor survival. Neo-adjuvant chemo-immunotherapy has gained benefits in a proportion of these patients. However no specific biomarker has been proved to predict the effect before therapy. In addition, the relationship of nodal status and survival after neo-adjuvant chemo-immunotherapy is still not well stated.

Methods: A total of 75 resectable NSCLC patients with N1/N2 stage who received neo-adjuvant chemo-immunotherapy plus surgery were retrospectively studied. The clinical characteristics, surgical information and safety parameters were collected. The correlations of major pathological response (MPR) and pathological complete response (pCR) with clinical data were analyzed. The progression free disease(PFS) and overall survival(OS) were evaluated with pathological response and nodal status.

Results: Of the 75 patients, 69 (92%) patients experienced treatment related adverse effects, while grade 3-4 adverse effects occurred in 8 (10%) patients. All the patients received surgical R0 resection with a MPR rate of 60% and a pCR rate of 36%. 67% of N1 patients and 77% of N2 patients had nodal clearance after neo-adjuvant treatment. A significant difference was observed between pathological response with age, histology and multiple lymph node metastasis. The PFS was better in the MPR cohort. The PFS was 90.1% and 83.6% at the nodal clearance group at the time of 12 and 18 months, compared with 70.1% and 63.7% at the nodal residual group.

Conclusions: The neo-adjuvant chemo-immunotherapy for locally advanced NSCLC with nodal positive was safe and feasible. The patients with elder age and squamous-cell carcinoma (SCC) were more likely to have better pathological response, while multiple nodal metastasis was a negative predictor. The clearance of lymph node resulted in significantly longer PFS and OS.

Keywords: Immunotherapy; Locally advanced NSCLC; Nodal status; Pathological response; Survivial.

MeSH terms

Aged
Carcinoma, Non-Small-Cell Lung* / drug therapy
Humans
Immunotherapy
Lung Neoplasms* / drug therapy
Lymphatic Metastasis
Neoadjuvant Therapy
Neoplasm Staging
Retrospective Studies

Abstract

MeSH terms

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