Respiratory investigation · 2026
Tumor cavitation at durvalumab initiation predicts poor survival in stage III NSCLC after concurrent chemoradiotherapy: A single-center retrospective cohort study.
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Ota Hiroaki, Sogabe Shota, Murakami Yosuke, Uchida Kazuki, Kawabata Takafumi, Hiramatsu Yuri, Sakabe Mitsukuni, Cho Katsuya, Yamamoto Ryuta, Ooi Ryunosuke, Sugimoto Takeya, Yoshimine Kohei, Nishizawa Saori, Ide Hiromi, Hanaka Minako, Tobino Kazunori
Аннотация
BACKGROUND: Concurrent chemoradiotherapy (CCRT) followed by durvalumab is standard treatment for unresectable stage III non-small cell lung cancer (NSCLC), but the clinical significance of tumor cavitation at durvalumab initiation is uncertain.
METHODS: We retrospectively studied consecutive patients treated at Iizuka Hospital between February 2018 and September 2024. Eligible patients had pathologically confirmed stage III NSCLC, completed platinum-based CCRT, and started durvalumab within 56 days. Cavitation was defined as a gas- or fluid-containing cavity measuring at least 5 mm within the primary tumor on computed tomography after CCRT and before durvalumab. Progression-free survival (PFS) from the first durvalumab infusion was the primary endpoint; overall survival (OS) and pulmonary events were secondary endpoints.
RESULTS: Of 36 eligible patients, 9 (25.0 %) had cavitation at durvalumab initiation; 3 had preexisting cavitation and 6 developed cavitation during or after CCRT. Median follow-up was 54.9 months. Cavitation was associated with shorter PFS (median, 3.7 vs. 19.3 months; hazard ratio [HR], 6.60; 95 % confidence interval [CI], 2.25-19.32) and OS (median, 10.6 months vs. not reached; HR, 26.46; 95 % CI, 5.24-133.75). The age-adjusted HRs were 5.62 (95 % CI, 1.79-17.66) for PFS and 12.05 (95 % CI, 2.16-67.29) for OS. Eight patients with cavitation discontinued durvalumab, and two died of grade 5 hemoptysis.
CONCLUSIONS: Tumor cavitation at durvalumab initiation identified a small subgroup with poor outcomes after CCRT. The finding supports closer surveillance but requires external validation.
METHODS: We retrospectively studied consecutive patients treated at Iizuka Hospital between February 2018 and September 2024. Eligible patients had pathologically confirmed stage III NSCLC, completed platinum-based CCRT, and started durvalumab within 56 days. Cavitation was defined as a gas- or fluid-containing cavity measuring at least 5 mm within the primary tumor on computed tomography after CCRT and before durvalumab. Progression-free survival (PFS) from the first durvalumab infusion was the primary endpoint; overall survival (OS) and pulmonary events were secondary endpoints.
RESULTS: Of 36 eligible patients, 9 (25.0 %) had cavitation at durvalumab initiation; 3 had preexisting cavitation and 6 developed cavitation during or after CCRT. Median follow-up was 54.9 months. Cavitation was associated with shorter PFS (median, 3.7 vs. 19.3 months; hazard ratio [HR], 6.60; 95 % confidence interval [CI], 2.25-19.32) and OS (median, 10.6 months vs. not reached; HR, 26.46; 95 % CI, 5.24-133.75). The age-adjusted HRs were 5.62 (95 % CI, 1.79-17.66) for PFS and 12.05 (95 % CI, 2.16-67.29) for OS. Eight patients with cavitation discontinued durvalumab, and two died of grade 5 hemoptysis.
CONCLUSIONS: Tumor cavitation at durvalumab initiation identified a small subgroup with poor outcomes after CCRT. The finding supports closer surveillance but requires external validation.