Prognostic significance of dynamic emotional distress during neoadjuvant therapy and surgery for resectable non-small cell lung cancer.

INTRODUCTION

Emotional distress (ED) is common in patients with non-small cell lung cancer (NSCLC), but the association between longitudinal ED patterns and survival during multimodality treatment remains unclear. We evaluated this association in patients with resectable NSCLC treated with neoadjuvant therapy and surgery.

METHODS

This multicenter retrospective study included 167 patients with pretreatment clinical stage IB-IIIB NSCLC who underwent neoadjuvant therapy and curative-intent resection between 2018 and 2022. ED was assessed before neoadjuvant therapy, before surgery, and three months postoperatively using HADS-A, HADS-D, GAD-7, and PHQ-9. For the primary analyses, positivity on any measure indicated ED positivity. Patients were classified as persistently negative (ED0), intermittently positive (ED1), or persistently positive (ED2). Survival was evaluated using Kaplan-Meier analysis and Cox regression.

RESULTS

Of the 167 patients, 47.3% were classified as ED0, 29.9% as ED1, and 22.8% as ED2. Median follow-up was 46 months. Three-year overall survival (OS) rates were 89.9%, 71.9%, and 57.9%, respectively (overall log-rank P < 0.001). In multivariable analyses, ED2 was associated with poorer OS (HR 5.04, 95% CI 2.55-9.99) and progression-free survival (PFS; HR 3.26, 95% CI 1.87-5.69) relative to ED0. Models combining ED and clinicopathologic variables had AUCs of 0.86 for OS and 0.80 for PFS.

CONCLUSIONS

Persistent ED was associated with poorer OS and PFS. Longitudinal ED assessment may help identify supportive care needs, but its added prognostic value requires further validation.