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Objective: The best treatment strategy for T4 non-small cell lung cancer (NSCLC) has yet to be defined. However, studies have shown that surgical resection benefits selected patients without N2/N3 disease. We aimed to determine the effect of neoadjuvant chemotherapy and/or radiation therapy on survival in patients with T4N0-1 NSCLC.
Methods: Between January 2002 and December 2020, 107 T4 patients who were operated on for NSCLC in our clinic were analyzed. Nine patients (8.3%) with T4N2 disease were excluded. Eighty-six patients (87.8%) received neoadjuvant high-dose radiation therapy and/or chemotherapy before resection. Twelve (12.2%) patients underwent surgical resection without induction chemotherapy or radiotherapy. Demographic characteristics, laboratory values, respiratory parameters, and pathological characteristics were recorded. Survival of the neoadjuvant+surgery and upfront surgery groups was calculated using the Kaplan–Meier test, while they were analyzed using both the log-rank test and Cox proportional-risk models.
Results: In the neoadjuvant and upfront surgery groups, 10-year survival rates were 58.3% and 45.0%, respectively (hazard ratio: 1.39; 95% CI: 0.519-3.302; P = .567). Median survival times were 58, respectively. After adjustment for potential confounding variables, no statistically significant difference was found between the 2 groups in terms of survival (hazard ratio: 1.26; 95% CI: 0.49-3.21, P = .631) compared with the surgery-alone group. In addition, N1 disease was not found to be an independent prognostic factor (hazard ratio: 1.26; 95% CI: 0.49-3.21, P = .631).
Conclusion: Aggressive treatment of T4N0 NSCLC with neoadjuvant chemotherapy and/or radiotherapy did not seem to prolong survival. Additionally, we did not find N1 to be a significant prognosticator. A prospective multicenter trial should evaluate these results.
Cite this article as: Özçıbık Işık G, Sarbay İ, Bulut Hİ, et al. Neoadjuvant treatment is not associated with better survival in T4 nonsmall cell lung cancer. Cerrahpaşa Med J. Published online July 17, 2024. doi:10.5152/cjm.2024.23116.