Initial single-institutional experience with salvage surgery for stage IV non-small-cell lung cancer

Area of Science:

• Oncology
• Thoracic Surgery
• Cancer Therapeutics

Background:

• Clinical stage IV non-small-cell lung cancer (NSCLC) historically has a poor prognosis.
• Multimodal treatment strategies are evolving for advanced NSCLC.
• The role of salvage surgery after systemic therapy in stage IV NSCLC requires further investigation.

Purpose of the Study:

• To evaluate surgical outcomes of salvage lung resection in patients with clinical stage IV non-small-cell lung cancer.
• To compare outcomes based on prior systemic therapy, specifically epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) versus non-TKI agents.

Main Methods:

• Retrospective analysis of 14 patients with clinical stage IV NSCLC who underwent lung resection between 2010 and 2022.
• Patients received neoadjuvant systemic therapy, including EGFR-TKIs or non-TKI agents (chemotherapy alone or with immune checkpoint inhibitors).
• Outcomes assessed included overall survival and relapse-free survival.

Main Results:

• The EGFR-TKI group had a 5-year overall survival of 83%, but this was attributed to post-relapse treatment, with no 4-year relapse-free survivors.
• The non-EGFR-TKI group demonstrated a 5-year relapse-free survival of 33%.
• Two patients in the non-EGFR-TKI group achieved over 3 years of relapse-free survival without further treatment.

Conclusions:

• Salvage surgery following non-TKI systemic therapy (chemotherapy with or without immune checkpoint inhibitors) can be considered a genuine salvage option for initial c-stage IV NSCLC.
• The findings support the integration of salvage surgery into multimodal treatment paradigms for selected stage IV NSCLC patients.
• Further research is warranted to optimize patient selection and treatment sequencing for salvage surgery in advanced NSCLC.