Lei Feitong, Sekkath-Veedu Janeesh, Huang Bin, Chen Quan, Shah-Jadeja Mansi, Stinchcombe Thomas E, Hao Zhonglin
Division of Cancer Biostatistics, Biostatistics and Bioinformatics Shared Resource Facility, Department of Medicine, Markey Comprehensive Cancer Center, University of Kentucky, Lexington, 40536 KY, USA; Biostatistics and Bioinformatics Shared Resource Facility, Markey Comprehensive Cancer Center, University of Kentucky, Lexington, 40536 KY, USA.
Department of Medicine, Markey Comprehensive Cancer Center, University of Kentucky, Lexington, 40536 KY, USA.
Clin Lung Cancer. 2025 Jan;26(1):e81-e90. doi: 10.1016/j.cllc.2024.10.007. Epub 2024 Oct 18.
Stage IIIA non-small cell lung cancers (NSCLC) are treated with surgery-based multimodality approach or definitive chemoradiation therapy plus durvalumab consolidation. It is not clear whether surgery-based multimodality therapy has any survival advantage over definitive chemoradiation plus immunotherapy consolidation.
National Cancer Database (NCDB) was used to identify NSCLC patients at stage IIIA (AJCC8, T3N1/T4N0-1 or T1N2/T2N2) who are treated with surgery-based multimodality approach or definitive chemoradiation plus durvalumab. Survival between groups were compared using inverse probability treatment weighting (IPTW)-adjusted Kaplan Meier curves and Cox proportional hazards regression analysis. Results were independently confirmed by Landmark Inverse and Clone Censor Weight analyses to address immortal time bias.
From 2017 to 2019, 24,170 patients are identified as potentially resectable stage IIIA (T3N1, T4N0-1, T1N2/T2N2). Among them, 2,615 (10.8%) received surgery-based multimodality therapy and 2,985 (12.4%) received definitive chemoradiation plus durvalumab. Surgery based multimodality approach had significant survival advantage over definitive chemoradiation plus durvalumab (HR 0.74; 95% CI 0.69-0.79, P < .001). The median overall survival (mOS) for the definitive chemoradiation plus durvalumab group was 48.59 m whereas mOS was not reached for surgery-based multimodality group. This trend persisted in both N2 negative and positive tumors. Neoadjuvant chemotherapy was just as effective as adjuvant chemotherapy and delay of immunotherapy consolidation to 12 weeks after initiation of chemoradiation did not negatively affect survival outcome.
For stage IIIA NSCLC patients, surgery-based multimodality treatment outperformed chemoradiation plus durvalumab in survival.
IIIA期非小细胞肺癌（NSCLC）采用以手术为基础的多模式方法或根治性放化疗加度伐利尤单抗巩固治疗。基于手术的多模式治疗相对于根治性放化疗加免疫治疗巩固是否具有生存优势尚不清楚。
使用国家癌症数据库（NCDB）来识别IIIA期（AJCC8，T3N1/T4N0-1或T1N2/T2N2）接受基于手术的多模式方法或根治性放化疗加度伐利尤单抗治疗的NSCLC患者。使用逆概率处理加权（IPTW）调整的Kaplan Meier曲线和Cox比例风险回归分析比较组间生存率。结果通过地标逆分析和克隆审查权重分析进行独立验证，以解决不朽时间偏差。
2017年至2019年期间，24,170例患者被确定为潜在可切除的IIIA期（T3N1，T4N0-1，T1N2/T2N2）。其中，2,615例（10.8%）接受了基于手术的多模式治疗，2,985例（12.4%）接受了根治性放化疗加度伐利尤单抗。基于手术的多模式方法相对于根治性放化疗加度伐利尤单抗具有显著的生存优势（HR 0.74；95% CI 0.69-0.79，P <.001）。根治性放化疗加度伐利尤单抗组的中位总生存期（mOS）为48.59个月，而基于手术的多模式组未达到mOS。这种趋势在N2阴性和阳性肿瘤中均持续存在。新辅助化疗与辅助化疗同样有效，将免疫治疗巩固延迟至放化疗开始后12周对生存结果没有负面影响。
对于IIIA期NSCLC患者，基于手术的多模式治疗在生存方面优于放化疗加度伐利尤单抗。
