The Journal of thoracic and cardiovascular surgery · 2026
Surgery versus definitive radiotherapy after induction immunochemotherapy for stage II and III non-small cell lung cancer: A multicenter, pragmatic analysis.
СтатьяМногоцентровое исследованиеСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Yang Zhenlin, Wang Shuaibo, Ni Jianjiao, Yu Xiangyang, Ju Mengyang, Zhu Linhai, Huang Xuhua, Zheng Bin, Zhang Guoqing, Li Renda, Xu Jiachen, Ni Chenhui, Chen Pan, Gao Cui, Liu Lipin, Xia Chuanbao, Liu Yiming, Li Yixing, Mao Yousheng, Guo Xiaotong, Chen Chun, Xue Zhiqiang, Zhang Guangjian, Hu Jian, Xue Qi, Gao Shugeng, Hu Bin, He Jie, NeoR-World Research Group
Аннотация
OBJECTIVES: Induction immunochemotherapy is the standard of care for resectable stage II and III non-small cell lung cancer. However, the comparative effectiveness of subsequent definitive surgery versus radiotherapy remains uncertain. We aimed to compare outcomes between these 2 strategies in routine clinical practice.
METHODS: This multicenter, retrospective cohort study included patients with stage II and III non-small cell lung cancer who received induction immunochemotherapy followed by surgery or definitive radiotherapy across 12 centers in China. Propensity score matching (1:2) was used to balance clinicopathological characteristics. The primary end point was progression-free survival; secondary end points included overall survival and recurrence patterns.
RESULTS: Among 967 patients (683 surgery; 284 radiotherapy), the matched intent-to-treat cohort included 548 patients (365 surgery; 183 radiotherapy). Compared with radiotherapy, surgery was associated with significantly longer progression-free survival (hazard ratio, 0.32; 95% CI, 0.23-0.44; P < .001) and overall survival (hazard ratio, 0.41; 95% CI, 0.26-0.66; P < .001). Surgery reduced overall recurrence (-21.3%; 95% CI, -31.1 to -11.3) and local recurrence (-17.5%; 95% CI, -25.0 to -9.9), but did not affect distant metastasis. In the subgroup of patients for whom pneumonectomy was indicated, surgery improved progression-free survival (hazard ratio, 0.47; 95% CI, 0.26-0.85; P = .013) but did not confer an overall survival benefit (hazard ratio, 1.14; 95% CI, 0.48-2.70; P = .76). Among patients who achieved a clinical complete response, outcomes were similar between the 2 groups.
CONCLUSIONS: Definitive surgery after induction immunochemotherapy offers superior progression-free survival and overall survival compared with definitive radiotherapy, primarily driven by improved local control. For patients requiring pneumonectomy or achieving a clinical complete response, treatment should be individualized, and prospective trials are warranted.
METHODS: This multicenter, retrospective cohort study included patients with stage II and III non-small cell lung cancer who received induction immunochemotherapy followed by surgery or definitive radiotherapy across 12 centers in China. Propensity score matching (1:2) was used to balance clinicopathological characteristics. The primary end point was progression-free survival; secondary end points included overall survival and recurrence patterns.
RESULTS: Among 967 patients (683 surgery; 284 radiotherapy), the matched intent-to-treat cohort included 548 patients (365 surgery; 183 radiotherapy). Compared with radiotherapy, surgery was associated with significantly longer progression-free survival (hazard ratio, 0.32; 95% CI, 0.23-0.44; P < .001) and overall survival (hazard ratio, 0.41; 95% CI, 0.26-0.66; P < .001). Surgery reduced overall recurrence (-21.3%; 95% CI, -31.1 to -11.3) and local recurrence (-17.5%; 95% CI, -25.0 to -9.9), but did not affect distant metastasis. In the subgroup of patients for whom pneumonectomy was indicated, surgery improved progression-free survival (hazard ratio, 0.47; 95% CI, 0.26-0.85; P = .013) but did not confer an overall survival benefit (hazard ratio, 1.14; 95% CI, 0.48-2.70; P = .76). Among patients who achieved a clinical complete response, outcomes were similar between the 2 groups.
CONCLUSIONS: Definitive surgery after induction immunochemotherapy offers superior progression-free survival and overall survival compared with definitive radiotherapy, primarily driven by improved local control. For patients requiring pneumonectomy or achieving a clinical complete response, treatment should be individualized, and prospective trials are warranted.