Abstract 650P
Background
The lymph nodes (LNs) status of patients with non-small cell lung cancer (NSCLC) after neoadjuvant chemoimmunotherapy is divided into ypN0 and ypN+. However, ypN0 patients include patients with LN metastasis before neoadjuvant treatment (cN+/ypN0) and patients who never develop LN metastasis (cN0/ypN0). The prognostic relationship between patients with different nodal status is unclear.
Methods
A retrospective analysis was conducted on patients with NSCLC who underwent surgery after neoadjuvant chemoimmunotherapy at four participating centers in China from 2019 to 2022. These patients were categorized into three groups based on their LN status before neoadjuvant therapy and post-surgery: “natural” N0 (cN0/ypN0), “downstaged” N0 (cN+/ypN0), and ypN+ (cN+/ypN+).
Results
We initially enrolled 375 patients. After data cleaning according to the inclusion criteria, the final analysis included 186 patients: 34 patients (18.3%) with “natural” N0, 95 patients (51.1%) with “downstaged” N0, and 57 patients (30.6%) with ypN+. The median follow-up was 24 months (range: 11-64 months). The 1-year and 2-year DFS rates were 100.0% and 93.8% in “natural” N0, 95.8% and 91.3% in “downstaged” N0, and 80.7% and 62.3% in ypN+ patients. The DFS of ypN+ patients was significantly lower than “natural” N0 patients and “downstaged” N0 patients (p < 0.001). However, there was no significant difference in DFS between “natural” N0 patients and “downstaged” N0 patients (p = 0.695). In the subgroup analysis combining MPR with LN status, the DFS of the MPR/ypN0 group was significantly better than that of the Non-MPR/ypN0 group (p = 0.008), MPR/ypN+ group (p = 0.028) and Non-MPR/ypN+ group (p < 0.001). However, there was no significant difference in the DFS of the Non-MPR/ypN0 group and the MPR/ypN+ group (p = 0.908). The Non-MPR/ypN+ group had the worst DFS.
Conclusions
Regardless of cN status, reaching ypN0 status after neoadjuvant chemoimmunotherapy for NSCLC serve as a predictor of favorable outcomes for patients. The combination of MPR and LN status can well distinguish the prognosis of patients with different conditons.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
The Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Medical Youth Talent (QNRC2016778), the Social Development Projects of Key R&D Programs in Xuzhou city (KC22097), the Social Development Projects of Key R&D Programs in Xuzhou city (KC22252),the Project of The Affiliated Hospital of Xuzhou Medical University(2021ZA05).
Disclosure
All authors have declared no conflicts of interest.