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Published on: February 12, 2017
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Lung cancer recurrence after neoadjuvant immunotherapy.
Hao Li1, Fatemehsadat Pezeshkian2, Yue Xie3
1Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Department of Thoracic Surgery, Institution of Thoracic Oncology, Peking University People's Hospital, Beijing, China.
Summary
Residual viable tumor percentage (%RVT) after neoadjuvant immunotherapy (Neo-IO) is a key predictor of lung cancer recurrence. Optimal cutoffs of 5% and 40% %RVT identify high-risk patients, guiding treatment decisions.
Area of Science:
- Oncology
- Immunotherapy
- Thoracic Surgery
Background:
- Neoadjuvant immunotherapy (Neo-IO) is increasingly used for resectable lung cancer.
- Predicting recurrence risk after Neo-IO and surgery is crucial for patient management.
- Residual viable tumor percentage (%RVT) is a potential prognostic marker.
Purpose of the Study:
- To evaluate recurrence risk and patterns after Neo-IO for resectable lung cancer.
- To identify optimal cutoffs for %RVT as a prognostic indicator.
Main Methods:
- Retrospective analysis of 94 patients with resectable non-small cell lung cancer treated with Neo-IO.
- Quantification of %RVT in surgical specimens using immune-related pathologic response criteria.
- Determination of optimal %RVT cutoffs for recurrence-free survival (RFS) using the Rhier function.
Main Results:
- Optimal %RVT cutoffs were identified at 5% and 40%.
- Higher %RVT (≥40%) was associated with significantly worse RFS (P=.006).
- %RVT was an independent risk factor for RFS (HR, 3.96; P=.015).
- Mediastinal lymph node recurrence increased with advanced ypN stage (ypN2: 25.0%).
Conclusions:
- %RVT is an independent predictor of lung cancer recurrence post-Neo-IO and resection.
- Cutoffs of 5% and 40% %RVT stratify recurrence risk.
- Consideration of postoperative radiotherapy for ypN2 patients due to high mediastinal LN recurrence.
