Lung resection after initial nonoperative treatment for non–small cell lung cancer Journal Article
| Authors: | Dunne, E. G.; Fick, C. N.; Tan, K. S.; Toumbacaris, N.; Mastrogiacomo, B.; Adusumilli, P. S.; Rocco, G.; Molena, D.; Huang, J.; Park, B. J.; Bott, M. J.; Rusch, V. R.; Sihag, S.; Isbell, J. M.; Chaft, J. E.; Li, B. T.; Gomez, D.; Rimner, A.; Bains, M. S.; Jones, D. R. |
| Article Title: | Lung resection after initial nonoperative treatment for non–small cell lung cancer |
| Abstract: | Objectives: The study objectives were to assess the outcomes of lung resection in patients with non–small cell lung cancer previously treated with nonoperative treatment and to identify prognostic factors associated with survival. Methods: Patients who underwent surgery (2010-2022) after initial nonoperative treatment at a single institution were identified from a prospectively maintained database. Exclusion criteria included metachronous cancer, planned neoadjuvant therapy, and surgery for diagnostic or palliative indications. Cox models were constructed for overall survival and event-free survival. Survival of patients with stage IV disease was compared with survival of a nonstudy cohort who did not undergo surgery. Results: In total, 120 patients met the inclusion criteria. Initial clinical stage was early stage in 16%, locoregionally advanced in 25%, and metastatic in 59% of patients. The indication for surgery was recurrence in 18%, local persistent disease in 23%, oligoprogression in 22%, and local control of oligometastatic disease in 38% of patients. Grade 3 or greater complications occurred in 5% of patients; 90-day mortality was 3%. Three-year event-free survival and overall survival were 39% and 73%, respectively. Male sex and lymphovascular invasion were associated with shorter event-free survival and overall survival; younger age and prior radiation therapy were associated with shorter overall survival. Patients with stage IV disease who received salvage lung resection had better overall survival than similar patients who received subsequent systemic therapy and no surgery. Conclusions: In this selected, heterogeneous population, lung resection after initial nonoperative treatment for non–small cell lung cancer was safe. Surgery as local consolidative therapy was associated with encouraging outcomes and should be considered for these patients. © 2023 The American Association for Thoracic Surgery |
| Keywords: | adult; cancer chemotherapy; controlled study; event free survival; treatment outcome; aged; middle aged; retrospective studies; major clinical study; overall survival; histopathology; mortality; salvage therapy; conference paper; cancer staging; follow up; antineoplastic agent; neoplasm staging; prospective study; progression free survival; carcinoma, non-small-cell lung; lung neoplasms; pneumonectomy; local therapy; cohort analysis; risk factors; pathology; retrospective study; risk factor; time factors; age; lung tumor; lung adenocarcinoma; immunotherapy; conservative treatment; brain metastasis; recurrent disease; surgery; targeted therapy; sex difference; factual database; databases, factual; therapy; non small cell lung cancer; cumulative incidence; progression-free survival; adverse event; time factor; salvage surgery; lymph vessel metastasis; humans; human; male; female; oligoprogressive disease; non–small cell lung cancer; oligometastatic disease; ex-smoker |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 168 |
| Issue: | 2 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2024-08-01 |
| Start Page: | 364 |
| End Page: | 373.e10 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2023.11.040 |
| PROVIDER: | scopus |
| PMCID: | PMC11136875 |
| PUBMED: | 38042400 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is David Jones -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work