Abstract 619P
Background
For locally NSCLC invading lobar bronchial orifice, sleeve lobectomy is the preferred surgical option. Neoadjuvant chemo-immunotherapy may allow R0 resection with lobectomy; accordingly, the benefits of sleeve lobectomy over lobectomy require re-consideration.
Methods
We retrospectively screened patients undergoing neoadjuvant chemo-immunotherapy followed by either lobectomy or sleeve lobectomy for NSCLC invading lobar bronchial orifice from March 2019 and April 2022. Disease-free survival (DFS) was compared between sleeve lobectomy and lobectomy groups in the original cohort and the inverse probability of treatment weighting (IPTW)-adjusted cohort. Cox regression was conducted to examine the potential association between surgical type and DFS.
Results
We initially enrolled 248 patients. After data cleaning according to the inclusion criteria, the final analysis included 68 (27.4%) patients: 38 undergoing lobectomy and 30 undergoing sleeve lobectomy. The 2-year DFS rate was 83.3% versus 60.5% in the sleeve and lobotomy groups, respectively (HR=0.46, 95% CI: 0.210-1.005, p = 0.057). In Cox regression analysis, improved DFS was associated with pCR (HR =0.27, 95% CI: 0.09 to 0.77; p = 0.014) but not sleeve lobectomy (HR =0.58 95% CI: 0.24-1.41; p = 0.2) after IPTW. In the subgroup analysis including pCR patients(n=31), median DFS was not reached in either group (p = 0.797) before and after IPTW. In the non-pCR subgroup (n=37), the median DFS was 21 months (95% CI: 13-NR) in the lobectomy group versus not achieved (95% CI: 25-NR) in the sleeve lobectomy group (p = 0.037) after IPTW.
Conclusions
Lobectomy could be feasible for pCR patients and there is survival advantage with sleeve lobectomy in patients who did not achieve pCR after neoadjuvant chemo-immunotherapy.
Clinical trial identification
Editorial acknowledgement
Writing and editorial assistance was provided by Kehong Zhang from Ivy Medical Editing (Shanghai, China).
Legal entity responsible for the study
H. Zhang.
Funding
This study was supported by the Social Development Projects of Key R&D Programs in Xuzhou City (KC22097 and KC22252).
Disclosure
All authors have declared no conflicts of interest.