Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability?
Introduction: Chemoradiation followed by durvalumab is considered a standard approach for patients with locally advanced NSCLC. With improvements in perioperative and neoadjuvant approaches, there is renewed interest in offering surgery to carefully selected patients with cT3/4N2 stage IIIB cancer....
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Elsevier
2025-01-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266636432400136X |
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| author | J. Humberto Rodriguez-Quintero, MD, MPH Rajika Jindani, MD, MPH, MS Roger Zhu, MD Isaac Loh Mohamed K. Kamel, MD Anne Montal, MD Marc Vimolratana, MD, MS Neel P. Chudgar, MD Nitin Ohri, MD, MS Balazs Halmos, MD, MS Brendon M. Stiles, MD |
| author_facet | J. Humberto Rodriguez-Quintero, MD, MPH Rajika Jindani, MD, MPH, MS Roger Zhu, MD Isaac Loh Mohamed K. Kamel, MD Anne Montal, MD Marc Vimolratana, MD, MS Neel P. Chudgar, MD Nitin Ohri, MD, MS Balazs Halmos, MD, MS Brendon M. Stiles, MD |
| author_sort | J. Humberto Rodriguez-Quintero, MD, MPH |
| collection | DOAJ |
| description | Introduction: Chemoradiation followed by durvalumab is considered a standard approach for patients with locally advanced NSCLC. With improvements in perioperative and neoadjuvant approaches, there is renewed interest in offering surgery to carefully selected patients with cT3/4N2 stage IIIB cancer. We sought to assess survival outcomes after surgery as part of a multimodality treatment regimen for these patients. Methods: Patients with cT3/T4N2M0 NSCLC who received surgery (S) as part of a multimodality approach and patients receiving multimodality treatment without surgery (chemoradiation [CRT] or systemic therapy only) were identified in the National Cancer Database (2010–2019). We evaluated factors associated with the receipt of S (logistic regression). After propensity matching, we estimated the overall survival (OS) of patients who received S and compared with those who received CRT (Kaplan-Meier and Cox regression). Results: A total of 44,756 patients were identified, of whom 3928 (8.8%) underwent S, 29,798 (66.6%) CRT, and 11,030 (24.6%) systemic therapy only. Fewer comorbidities (Charlson-Deyo index 0 or 1, adjusted OR [aOR]: 1.22, 95% confidence interval [CI]: 1.05–1.42), treatment at an academic facility (aOR: 1.70, 95% CI: 1.52–1.89), private insurance (aOR: 2.44, 95% CI: 1.61–3.69), adenocarcinoma histology (aOR: 1.48, 95% CI: 1.22–1.79), and clinical T3 stage (<7 cm, aOR: 1.70, 95% CI: 1.53–1.89) were associated with S. In well-balanced, propensity-matched cohorts, patients selected for S had better OS compared with those who underwent CRT (hazard ratio 0.59, 95% CI: 0.56–0.63, p < 0.001) (median OS 49.7 versus 25.0 mo). Conclusions: In this retrospective cohort analysis, patients with cT3/4N2, stage IIIB NSCLC who underwent surgical resection had better OS compared with those patients treated with CRT. Careful patient selection is undoubtedly critical, but stage IIIB designation alone should not exclude patients from surgical consideration. |
| format | Article |
| id | doaj-art-6d1b5ef2d6f84d288bce95b7a4494ce2 |
| institution | Kabale University |
| issn | 2666-3643 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj-art-6d1b5ef2d6f84d288bce95b7a4494ce22025-01-20T04:17:55ZengElsevierJTO Clinical and Research Reports2666-36432025-01-0161100766Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability?J. Humberto Rodriguez-Quintero, MD, MPH0Rajika Jindani, MD, MPH, MS1Roger Zhu, MD2Isaac Loh3Mohamed K. Kamel, MD4Anne Montal, MD5Marc Vimolratana, MD, MS6Neel P. Chudgar, MD7Nitin Ohri, MD, MS8Balazs Halmos, MD, MS9Brendon M. Stiles, MD10Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Medical Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New YorkDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Corresponding author. Address for correspondence: Brendon M. Stiles, MD, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge, Bronx, New York.Introduction: Chemoradiation followed by durvalumab is considered a standard approach for patients with locally advanced NSCLC. With improvements in perioperative and neoadjuvant approaches, there is renewed interest in offering surgery to carefully selected patients with cT3/4N2 stage IIIB cancer. We sought to assess survival outcomes after surgery as part of a multimodality treatment regimen for these patients. Methods: Patients with cT3/T4N2M0 NSCLC who received surgery (S) as part of a multimodality approach and patients receiving multimodality treatment without surgery (chemoradiation [CRT] or systemic therapy only) were identified in the National Cancer Database (2010–2019). We evaluated factors associated with the receipt of S (logistic regression). After propensity matching, we estimated the overall survival (OS) of patients who received S and compared with those who received CRT (Kaplan-Meier and Cox regression). Results: A total of 44,756 patients were identified, of whom 3928 (8.8%) underwent S, 29,798 (66.6%) CRT, and 11,030 (24.6%) systemic therapy only. Fewer comorbidities (Charlson-Deyo index 0 or 1, adjusted OR [aOR]: 1.22, 95% confidence interval [CI]: 1.05–1.42), treatment at an academic facility (aOR: 1.70, 95% CI: 1.52–1.89), private insurance (aOR: 2.44, 95% CI: 1.61–3.69), adenocarcinoma histology (aOR: 1.48, 95% CI: 1.22–1.79), and clinical T3 stage (<7 cm, aOR: 1.70, 95% CI: 1.53–1.89) were associated with S. In well-balanced, propensity-matched cohorts, patients selected for S had better OS compared with those who underwent CRT (hazard ratio 0.59, 95% CI: 0.56–0.63, p < 0.001) (median OS 49.7 versus 25.0 mo). Conclusions: In this retrospective cohort analysis, patients with cT3/4N2, stage IIIB NSCLC who underwent surgical resection had better OS compared with those patients treated with CRT. Careful patient selection is undoubtedly critical, but stage IIIB designation alone should not exclude patients from surgical consideration.http://www.sciencedirect.com/science/article/pii/S266636432400136XUnresectableDefinitive chemoradiationStage IIIB NSCLCNeoadjuvant therapyPerioperative approaches |
| spellingShingle | J. Humberto Rodriguez-Quintero, MD, MPH Rajika Jindani, MD, MPH, MS Roger Zhu, MD Isaac Loh Mohamed K. Kamel, MD Anne Montal, MD Marc Vimolratana, MD, MS Neel P. Chudgar, MD Nitin Ohri, MD, MS Balazs Halmos, MD, MS Brendon M. Stiles, MD Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability? JTO Clinical and Research Reports Unresectable Definitive chemoradiation Stage IIIB NSCLC Neoadjuvant therapy Perioperative approaches |
| title | Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability? |
| title_full | Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability? |
| title_fullStr | Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability? |
| title_full_unstemmed | Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability? |
| title_short | Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability? |
| title_sort | surgery for patients with ct3 4n2m0 stage iiib nsclc is it time to redefine resectability |
| topic | Unresectable Definitive chemoradiation Stage IIIB NSCLC Neoadjuvant therapy Perioperative approaches |
| url | http://www.sciencedirect.com/science/article/pii/S266636432400136X |
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