Neoadjuvant Chemoimmunotherapy Followed by Surgery or Radiotherapy for Stage IIIA-B Non-Small Cell Lung Cancer With Bulky N2 Disease.

Abstract

The optimal treatment for stage III non-small cell lung cancer (NSCLC) patients with bulky N2 disease remains controversial. This study evaluated the efficacy of neoadjuvant chemoimmunotherapy followed by surgery or radiotherapy in these patients. Patients diagnosed with stage III (N2) NSCLC with bulky N2 disease who received neoadjuvant chemoimmunotherapy between January 2019 and January 2023 at our institution were retrospectively reviewed. Kaplan-Meier curves and log-rank tests were used to analyze differences in event-free survival (EFS) and overall survival (OS) between the surgery and radiotherapy groups. Cox proportional hazards regression was applied to identify independent risk factors. Included were 65 patients without disease progression after neoadjuvant chemoimmunotherapy: 43 (66.2%) underwent surgery and 22 (33.8%) received radiotherapy. The median follow-up time was 45.3 months. The 3-year EFS and OS rates for the entire cohort were 53.7% and 81.2%, respectively. In multivariable Cox regression analyses, the surgery group showed significantly longer EFS (hazard ratio, 0.15; P = .003) and OS (hazard ratio, 0.18; P = .046) than the radiotherapy group. R0 resection rate was 100%. The major and complete pathological response rates in the surgery group were 55.8% and 27.9%, respectively. Surgery is a feasible and effective consolidative strategy in a carefully selected subgroup of patients with bulky N2 disease who respond favorably to neoadjuvant chemoimmunotherapy.