Annals of surgical oncology · 2026
A Novel Prognostic Stratification for Patients with Non-small Cell Lung Cancer Following Surgical Resection After Neoadjuvant Therapy: A Retrospective Cohort Study.
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Ao Yongqiang, Han Zheng, Xia Mingyu, Wen Jiazhe, Wang Caiying, Liang Fei, Xu Bei, Wang Haikun, Wang Shuai, Gao Jian, Jiang Jiahao, Ding Jianyong
Аннотация
BACKGROUND: The purpose of this study was to assess the combined prognostic value of residual viable tumor (RVT) percentage and post-neoadjuvant lymph node (ypN) status in lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC), and to develop a novel histology-based risk stratification model.
PATIENTS AND METHODS: We analyzed a cohort of 352 patients with non-small cell lung cancer (NSCLC) who underwent neoadjuvant therapy followed by resection. Histology-specific RVT cutoffs were determined using maximally selected rank statistics and time-dependent receiver operating characteristic (ROC) analysis, with stability assessed via bootstrap resampling. A three-tier model integrating RVT and ypN was created: low risk (RVTlow and ypN0), intermediate-risk (RVTlow and ypN+ or RVThigh and ypN0), and high risk (RVThigh and ypN+). Survival differences were evaluated using Kaplan-Meier and log-rank tests, with prognostic risks assessed by Cox models.
RESULTS: The cohort included 155 patients with LUAD and 197 with LUSC (mean age 61.6 years; median follow-up 41 months). Major pathological and pathological complete response rates were 20.6% in LUAD and 45.2% in LUSC, with a significantly higher median RVT percentage in LUAD than in LUSC (60% versus 30%, p < 0.0001). Optimized prognostic RVT cutoffs were established at 65% in LUAD and 25% in LUSC, strongly stratifying both OS and RFS (all p < 0.0001). The three-tier risk model significantly stratified RFS and OS in both LUAD and LUSC cohorts (overall p < 0.0001), with all intergroup comparisons remaining significant (all p < 0.05). On multivariable analysis, compared with the low-risk group, the intermediate- and high-risk groups were associated with significantly increased risks of death and recurrence in both LUAD and LUSC. Bootstrap validation demonstrated minimal overfitting (optimism 0.000-0.001) and maintained discriminative ability for both RFS (C-indices: LUAD 0.646, LUSC 0.713) and OS (C-indices: LUAD 0.642, LUSC 0.744).
CONCLUSIONS: We established a novel histology-specific risk model for resected NSCLC after neoadjuvant therapy. This practical tool may help discriminate prognosis and guide personalized postoperative management.
PATIENTS AND METHODS: We analyzed a cohort of 352 patients with non-small cell lung cancer (NSCLC) who underwent neoadjuvant therapy followed by resection. Histology-specific RVT cutoffs were determined using maximally selected rank statistics and time-dependent receiver operating characteristic (ROC) analysis, with stability assessed via bootstrap resampling. A three-tier model integrating RVT and ypN was created: low risk (RVTlow and ypN0), intermediate-risk (RVTlow and ypN+ or RVThigh and ypN0), and high risk (RVThigh and ypN+). Survival differences were evaluated using Kaplan-Meier and log-rank tests, with prognostic risks assessed by Cox models.
RESULTS: The cohort included 155 patients with LUAD and 197 with LUSC (mean age 61.6 years; median follow-up 41 months). Major pathological and pathological complete response rates were 20.6% in LUAD and 45.2% in LUSC, with a significantly higher median RVT percentage in LUAD than in LUSC (60% versus 30%, p < 0.0001). Optimized prognostic RVT cutoffs were established at 65% in LUAD and 25% in LUSC, strongly stratifying both OS and RFS (all p < 0.0001). The three-tier risk model significantly stratified RFS and OS in both LUAD and LUSC cohorts (overall p < 0.0001), with all intergroup comparisons remaining significant (all p < 0.05). On multivariable analysis, compared with the low-risk group, the intermediate- and high-risk groups were associated with significantly increased risks of death and recurrence in both LUAD and LUSC. Bootstrap validation demonstrated minimal overfitting (optimism 0.000-0.001) and maintained discriminative ability for both RFS (C-indices: LUAD 0.646, LUSC 0.713) and OS (C-indices: LUAD 0.642, LUSC 0.744).
CONCLUSIONS: We established a novel histology-specific risk model for resected NSCLC after neoadjuvant therapy. This practical tool may help discriminate prognosis and guide personalized postoperative management.