Multimodal Therapy for T4 N2 Non-Small Cell Lung Cancer With Additional Ipsilateral Pulmonary Nodules

Area of Science:

• Thoracic Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Optimal treatment for T4 non-small cell lung cancer (NSCLC) with ipsilateral nodules (T4-Add) across N stages is unclear.
• This study focuses on T4-Add N2 NSCLC, comparing surgical resection with chemotherapy versus concurrent chemoradiation.

Purpose of the Study:

• To evaluate and compare the long-term survival outcomes for patients with T4-Add N2 NSCLC.
• To determine if multimodal therapy including surgery improves survival compared to chemoradiation alone.

Main Methods:

• Analysis of the National Cancer Database (2010-2015) for patients with T4-Add N2 M0 NSCLC.
• Comparison of survival between surgical resection with chemotherapy and chemoradiation groups using Kaplan-Meier, Cox modeling, and propensity score matching.
• Inclusion of 9 prognostic variables, including comorbidities, for propensity score matching.

Main Results:

• 499 eligible patients: 220 (44.1%) had surgery with chemotherapy, 279 (55.9%) had chemoradiation.
• Multivariable analysis showed surgical resection with chemotherapy was associated with better long-term survival.
• Propensity score-matched analysis (100 patients per group) confirmed better 5-year overall survival for the surgical group.

Conclusions:

• Multimodal therapy including surgery may improve survival for T4 N2 NSCLC with additional nodules compared to chemoradiation.
• Surgical resection should be considered for carefully selected patients with T4-Add N2 disease.
• Further research is warranted to confirm these survival benefits.