Efficacy and Safety of Salvage Surgery After Immunotherapy in Non-small Cell Lung Cancer: A Multi-institutional
Shinya Tane1, Megumi Nishikubo2, Takehiko Manabe3
1Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. shinyatane@gmail.com.
Background:
With the widespread adoption of immune checkpoint inhibitors (ICIs) for advanced non-small cell lung cancer (NSCLC), local recurrence after immunotherapy has become increasingly frequent. However, limited evidence is available regarding salvage surgery after ICI therapy.
Methods:
A multi-institutional retrospective study (CReGYT-05 Immune Checkpoint Inhibitor-Salvage Study) was conducted across 14 centers in Japan, evaluating patients who underwent salvage surgery after ICI therapy between 2016 and 2023. Salvage surgery was classified as conversion surgery (downstaging from initially unresectable to resectable disease) or true salvage surgery (surgery for local recurrence or residual disease). The primary endpoints included perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS).
Results:
The study analyzed 32 patients. Radiologic response to ICI therapy showed complete response in 4 patients (12.5 %), partial response in 23 patients (71.9 %), and stable disease in 5 patients (15.6 %). Salvage procedures comprised true salvage surgery (n = 17, 53.1 %) and conversion surgery (n = 15, 46.9 %). Lobectomy was performed for 84.4 % of the patients. Perioperative complications occurred in eight (25.0 %) of the patients, with no perioperative mortality. Pathologic complete response was achieved for six (18.8 %) patients. The 3- and 5-year OS rates from the initial diagnosis were 86.9 % and 77.2 %, respectively. Conversion surgery demonstrated superior 3-year RFS compared with true salvage surgery (92.8 % vs 36.3 %; p = 0.010). Univariable analysis identified salvage type as a significant factor for RFS.
Conclusions:
Salvage surgery after ICI therapy can be safely performed and is associated with encouraging survival outcomes for carefully selected patients, particularly those undergoing conversion surgery.
