Randomized phase III NATCH trial in early-stage non-small cell lung cancer (NSCLC) patients (p) reported no statistically differences in disease-free survival (DFS) or overall survival (OS) with the addition of preoperative or adjuvant chemotherapy to surgery. In pre-operative arm, those p who achieved a complete response obtained a benefit in 5-year DFS rate (59% vs. 38%). Recently, major pathological response (MPR) to preoperative chemotherapy (10% or less of residual viable tumor after preoperative therapy) has reported as surrogate marker of OS. The aim of this study is to validate MPR as prognostic factor in a cohort of patients included the NATCH trial.
MPR was analysed in a whole cohort of 57 early-stage NSCLC p treated in the preoperative arm into NATCH trial from 2 institutions. OS according to MPR was analysed (long-rank test) in the whole population and by histologic subtype.
In this cohort, median age was 67 years (47-78), 48 p (84%) were males, 26 p (46%) squamous subtype. By stage according to 6th TNM: 9 p (16%) stage IA, 35 p (61%) stage IB, 12 p (21%) stage IIB and 1 p (2%) stage IIIA. 95% p completed 3 cycles of preoperative treatment. Surgical procedures: 81% lobectomies, 14% pneumonectomies, 5% no surgery. 13 out of 57 p (22.8%) had MPR. In the whole population, there was an increase in 5-year OS among those patients with MPR compare to p without MPR (84.6% vs. 58.5%, p = 0.106). According to histological subtype, 5-year OS in squamous NSCLC p with MPR was significantly longer than in p without MPR (100% vs. 47.1%, p = 0.026), but not differences in OS in non-squamous were detected (66.7% vs. 66.7%, p = 0.586).
MPR is a prognostic value in squamous NSCLC p who receive preoperative chemotherapy. Validation in extended cohort merits further evaluation.
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All authors have declared no conflicts of interest.