Conversion Surgery After Induction Therapy for Initially Unresectable Stage III Non-small Cell Lung Cancer: A...

Area of Science:

• Thoracic Surgery
• Oncology
• Immunotherapy

Background:

• Stage III non-small-cell lung cancer (NSCLC) often presents as unresectable.
• Induction therapy followed by conversion surgery is being explored for these patients.
• This study aimed to prove the concept of conversion surgery after induction therapy.

Purpose of the Study:

• To evaluate the safety and feasibility of conversion surgery in initially unresectable stage III NSCLC.
• To assess perioperative morbidity and survival outcomes.
• To explore transcriptomic characteristics associated with therapeutic response.

Main Methods:

• Prospective, single-arm, open-label study of 30 patients with initially unresectable stage III NSCLC.
• Patients received induction therapy (including immunochemotherapy - ICT) followed by surgical evaluation.
• Bulk-RNA sequencing analyzed baseline and post-treatment samples to identify response predictors.

Main Results:

• High R0 resection rate (93.3%) achieved.
• Postoperative morbidity was 33.3%, with major and complete pathologic response rates of 66.7% and 26.7%, respectively.
• Encouraging 1-year event-free (87.5%) and overall survival (96.7%) rates were observed. B cell immunity correlated with pathologic response and predicted survival in the ICT cohort.

Conclusions:

• Conversion surgery is a safe and feasible option for selected patients with initially unresectable stage III NSCLC.
• Radical surgery plays a crucial role in the treatment strategy for this patient group.
• A B cell-related gene set shows potential as a predictive biomarker for immunotherapy response.