Thorac Cardiovasc Surg 2020; 68(07): 639-645
DOI: 10.1055/s-0039-1679884
Original Thoracic

Major Pathologic Response after Induction Therapy Has a Long-Term Impact on Survival and Tumor Recurrence in Stage IIIA/B Locally Advanced NSCLC

Waldemar Schreiner
1  Division of Thoracic Surgery, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany
,
Wojciech Dudek
1  Division of Thoracic Surgery, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany
,
Ralf Joachim Rieker
2  Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany
,
Sebastian Lettmaier
3  Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany
,
Rainer Fietkau
3  Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany
,
Horia Sirbu
1  Division of Thoracic Surgery, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany
› Author Affiliations

Abstract

Background Major pathologic response (MPR) determines favorable outcome in locally advanced non-small cell lung cancer after induction therapy (IT) followed by lung resection. The aim of this retrospective study was to identify the prognostic relevance of MPR in long-term interval.

Methods In 55 patients, the survival rate according to MPR and non-MPR was estimated by Kaplan–Meier method and compared using log-rank, Breslow, and Tarone–Ware tests.

Results The IT included chemoradiation with 50.4 Gy (range: 45–56.4 Gy) combined with platinum-based chemotherapy in 52 patients (94.5%) and platinum-based chemotherapy in 3 patients (5.5%). Perioperative morbidity and 30-day mortality were 36 and 3.6%, respectively. The estimated 5-year postoperative and progressive-free survivals were statistically significantly improved in MPR versus non-MPR with 53.5 versus 18% and 49.4 versus 18.5%, respectively. According to the log-rank, Breslow, and Tarone–Ware tests, the MPR demonstrates prognostic significance in early, long-term, and whole postoperative interval.

Conclusion MPR is associated with a robust correlation to long-term postoperative and recurrence-free survival improvement, and can potentially simplify the multidisciplinary debate and allow further stratification of adjuvant treatment in multimodality therapy.



Publication History

Received: 01 October 2018

Accepted: 14 January 2019

Publication Date:
26 February 2019 (online)

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