A retrospective analysis of neoadjuvant chemotherapy in pneumonectomy for locally advanced central non-small cell...

The treatment of patients with locally advanced central non-small cell lung cancer (NSCLC) remains controversial. This study aimed to evaluate the effects of neoadjuvant chemotherapy in patients undergoing pneumonectomy.

A retrospective analysis was conducted on patients who underwent pneumonectomy with or without neoadjuvant chemotherapy for locally advanced central NSCLC between 2014 and 2019. Categorical variables were compared using the Chi-square or Fisher's exact test. Survival analysis was performed using the Kaplan-Meier method, with comparisons made via the log-rank test. Multivariate analysis of independent prognostic factors was conducted using the Cox proportional hazards regression model. A p-value < 0.05 was considered statistically significant.

Based on inclusion and exclusion criteria, 104 patients were selected from a total of 6,930, including 69 who received neoadjuvant chemotherapy and 35 who did not. Univariate analysis showed that the neoadjuvant chemotherapy group had significantly improved 5-year overall survival (OS: 29.1% vs. 12.8%, ${\chi }^2$ = 4.089, p = 0.043) and disease-free survival (DFS: 22.3% vs. 8.8%, ${\chi }^2$ = 3.941, p = 0.047). The downstaging rate in the neoadjuvant chemotherapy group was 29.0%. Subgroup analysis revealed that patients with downstaging had significantly better 5-year OS and DFS compared to those without downstaging (OS: 56.6% vs. 17.1%, ${\chi }^2$ = 10.266, p = 0.001; DFS: 54.1% vs. 6.0%, ${\chi }^2$ = 20.785, p < 0.001). Another subgroup analysis showed that although 5-year DFS was 0% in both groups, patients with stage cN2 disease who received neoadjuvant chemotherapy had better 5-year OS (16.3% vs. 7.8%, ${\chi }^2$ = 5.603, p = 0.018) and a statistically significant difference in DFS ( ${\chi }^2$ = 7.328, p = 0.007).

Neoadjuvant chemotherapy significantly improves prognosis in patients with locally advanced central NSCLC undergoing pneumonectomy. Multivariate analysis confirms its positive impact on survival. Patients who experience downstaging after neoadjuvant chemotherapy show notably better outcomes. For patients with stage cN2 disease, neoadjuvant chemotherapy is associated with improved survival.