Neoadjuvant chemoimmunotherapy, whether compared to immunotherapy alone or in combination with apatinib, may lead to increased surgical complexity while maintaining an acceptable incidence of postoperative complications, according to the results of a retrospective study.
Lung cancer, specifically non-small cell lung cancer (NSCLC), is the leading cause of cancer-related deaths worldwide, accounting for nearly 85% of cases. The primary approach to managing early-stage NSCLC involves surgical intervention, which is supplemented with chemotherapy and radiotherapy to improve patient prognosis.
However, the surgical removal of some resectable tumors, particularly stage III tumors, poses challenges due to factors such as tumor size, location, and metastases. Despite complete resection, these patients experience high rates of recurrence and mortality.
The introduction of neoadjuvant immunotherapy offers a promising prospect for the successful treatment of resectable NSCLC, as explored in a retrospective study published in the journal Thoracic Cancer. The study focuses on identifying risk factors and potential post-surgery issues.
Study Participants
The median age of the study population was 61 years, with most patients being male (85.8%). A significant portion (72.4%) had a history of smoking, while the majority (76.2%) reported no family history of cancer. Preoperative performance status scores indicated a good tolerance for surgery in most patients (78.8% with an Eastern Cooperative Oncology Group (ECOG) score of 0).
Surgical Trends in Central-Type NSCLC
Central-type NSCLC was observed in 61.7% of cases, with the left upper lobe being the most common tumor location (30.7%). Lobectomy was performed in 53.3% of cases, and video-assisted thoracoscopic surgery (VATS) was the primary surgical approach (53.6%). The median interval from ICI therapy to surgery was 42 days.
Unexpected Events in Lung Cancer Surgery
Unexpected events during surgery included vascular complications, dense adhesions, and complex hilar anatomy. Conversion to open thoracotomy was necessary for a small subset of patients (3.4%). A challenging surgery, defined as exceeding the average surgical duration, was experienced by 43.7% of the patients. The average number of lymph nodes resected was 25.5. Postoperatively, 1.5% of patients died within 30 days, and 2.3% died within 90 days.
Postoperative Complications and Associated Factors
Postoperative complications exceeding Clavien–Dindo grade 2 were observed in 22.2% of patients. Pneumonia (5.4%) and pleural effusion requiring intervention (5.4%) were the most frequent complications. Unfortunately, the study reported a 30-day mortality rate of 1.5% (4 patients) and a 90-day mortality rate of 2.3% (6 patients). Logistic regression analyses revealed thoracotomy, pneumonectomy, challenging surgeries, and blood loss as risk factors for severe postoperative complications.
Immunotherapy Yields High Response
The study reported a major pathological response (MPR) rate of 52.5% (137 patients) and a pathological complete response (pCR) rate of 30.3% (79 patients) following neoadjuvant immunotherapy. Downstaging of the tumor stage (T stage) and lymph node involvement (N stage) was observed in 72.8% and 49.0% of patients, respectively. The analysis revealed that the apatinib-based regimen achieved a significantly higher MPR rate compared to chemoimmunotherapy. Conversely, the chemoimmunotherapy group had a significantly higher pCR rate compared to the immunotherapy group alone.
Source:
Bai, G., Chen, X., Yue, P., Ji, Y., Bie, F., Liu, Y., Yang, Z., & Gao, S. (2024). Surgery challenges and postoperative complications of lung cancer after neoadjuvant immunotherapy. Thoracic Cancer. https://doi.org/10.1111/1759-7714.15297
