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Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability?
J Humberto Rodriguez-Quintero1, Rajika Jindani1, Roger Zhu1
1Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
JTO Clinical and Research Reports
|January 6, 2025
Summary
Surgery improves survival for stage IIIB non-small cell lung cancer (NSCLC) patients with cT3/4N2 disease. Careful patient selection is crucial, but stage IIIB NSCLC should not automatically preclude surgical consideration.
Area of Science:
- Oncology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Chemoradiation followed by durvalumab is standard for locally advanced NSCLC.
- There's growing interest in surgery for selected stage IIIB NSCLC patients with cT3/4N2 disease.
Purpose of the Study:
- To assess survival outcomes after surgery in a multimodality treatment regimen for stage IIIB NSCLC patients with cT3/4N2 disease.
Main Methods:
- Retrospective analysis of the National Cancer Database (2010-2019) for patients with cT3/4N2M0 NSCLC.
- Compared survival outcomes between patients who received surgery (S) and those who received chemoradiation (CRT) after propensity matching.
Main Results:
- Surgery was associated with fewer comorbidities, academic treatment facility, private insurance, adenocarcinoma histology, and clinical T3 stage.
- Propensity-matched analysis showed significantly better overall survival (OS) for patients who underwent surgery (median OS 49.7 months) compared to CRT (median OS 25.0 months).
Conclusions:
- Surgical resection in a multimodality approach is associated with improved OS for stage IIIB NSCLC patients with cT3/4N2 disease.
- Stage IIIB designation should not exclude patients from surgical consideration if carefully selected.
Keywords:
Definitive chemoradiationNeoadjuvant therapyPerioperative approachesStage IIIB NSCLCUnresectable
