A retrospective analysis finds that patients who undergo pneumonectomy or are aged 70 years or older after receiving neoadjuvant concurrent chemoradiation therapy experience less favorable surgical outcomes.
Lung cancer, particularly stage IIIA–N2 non-small cell lung cancer (NSCLC), is one of the leading causes of cancer-related deaths worldwide. The most effective treatment approach for this type of cancer is still under consideration; however, neoadjuvant therapies, such as chemotherapy and chemoradiotherapy, are increasingly being favored for their ability to improve locoregional control and eradicate mediastinal lymph node metastasis.Notably, this approach carries a higher risk of postoperative complications, which is a significant concern relative to patient recovery.
In this case review study, published in the Journal of Chest Surgery, researchers performed a retrospective analysis to examine perioperative outcomes and identify the risk factors that influence morbidity and mortality following tri-modality therapy for NSCLC.
Study Participants:
The study included 574 patients, with a median age of 60 years and predominantly male (77.4%). The majority (98.6%) of patients had an Eastern Cooperative Oncology Group (ECOG) performance status score of 0. A significant proportion of the group (59.1%) had a smoking history.
Preoperative Neoadjuvant CCRT and Treatment Regimen
All patients received neoadjuvant concurrent chemoradiation therapy (nCCRT) before the procedure. The histological subtype with the highest frequency was adenocarcinoma, accounting for 56.1% of cases, followed by squamous cell carcinoma at 36.6%. The radiation dose had a median value of 45 Gy, and a significant majority of patients (97.4%) achieved a partial response to CCRT. The median duration from the completion of CCRT to the surgical procedure was 33 days.
Lobectomy Most Frequent Surgery After Neoadjuvant CCRT
The surgical technique with the highest frequency of occurrence was lobectomy, conducted on 440 patients. This was followed by bilobectomy, performed on 57 patients, and pneumonectomy, performed on 73 patients. Ninety-five percent of patients achieved complete resection. A significant proportion of patients (57%) underwent adjuvant therapy subsequent to the surgical procedure. The pathological study demonstrated a complete response in 13% of the patients, while over half (53%) had mediastinal nodal downstaging.
Postoperative Hospital Stay and Mortality Correlate With Surgical Extent
The average duration of hospitalisation was 8 days. Postoperative mortality occurred in 1.4% of patients within 30 days, and 7.1% within 90 days. There was a correlation between the degree of surgical intervention and the rates of both morbidity and mortality.
Postoperative Morbidity and Mortality After Neoadjuvant CCRT
The overall morbidity rate was found to be 34.7%, with arrhythmia (20.2%), prolonged air leak (6.1%), and pneumonia (5.6%) emerging as the most commonly observed consequences. Multiple independent risk variables for postoperative morbidity were discovered, including male gender, age above 70 years, non-adenocarcinoma histology, smoking history, low body mass index (BMI), and the occurrence of pneumonectomy. Likewise, age above 70 and the occurrence of pneumonectomy were identified as independent risk factors associated with postoperative mortality during 90 days.
Source:
Jeong, G. H., Lee, J., Jeon, Y. J., Park, S. Y., Kim, H. K., Choi, Y. S., Kim, J. G., Shim, Y. M., & Cho, J. H. (2024b). Risk Factor Analysis of Morbidity and 90-Day Mortality of Curative Resection in Patients with Stage IIIA–N2 Non-Small Cell Lung Cancer after Induction Concurrent Chemoradiation Therapy. Journal of Chest Surgery. https://doi.org/10.5090/jcs.23.165
