Abstract 608P
Background
Radical surgery after neoadjuvant immunochemotherapy treatment (NICT) is an important strategy for curing lung cancer clinically. Early surgery or delayed surgery could be responsible for reducing the therapeutic effect. Robust evidence on the optimal time interval between neoadjuvant therapy and surgery remains scant. The purpose of this study was to determine the relation between the timing of surgery after NICT and outcomes of surgery and pathological response.
Methods
The patients were divided into 3 groups depending on the wait time between completion of NICT and surgery in this retrospective study: short-interval group(SIG;<4 weeks),intermediate-interval group(IIG;4-6 weeks),and long-interval group(LIG;>6 weeks). The primary endpoints were disease-free survival (DFS) and overall survival (OS), while the secondary endpoints were pathological response, surgical outcomes, and postoperative complications. DFS and OS were estimated by the Kaplan-Meier analysis and the log-rank test.
Results
Among the 205 patients, 174 were male (84.9%), and the median (IQR) age was 62.0(56.0-68.0) years. There were 59 patients (28.8%) in the SIG, 108 patients (52.7%) in the IIG and 38 patients (18.5%) in the LIG. The median surgical interval was 3.6 weeks for the SIG, 4.7 weeks for the IIG and 6.7 weeks for the LIG. The overall pathological complete response (pCR) was 34.4%. When compared with the IIG, a significant correlation was observed between time interval and pCR in SIG (odds ratio[OR], 0.30; 95% CI, 0.14-0.63; P=0.002), expect LIG (OR, 0.67; 95% CI,0.31-1.46; P=0.317). Besides, there was a association between time interval and pleural adhesions in LIG (OR, 3.37; 95% CI, 1.38-8.27; P=0.008), except SIG (OR, 0.98; 95% CI, 0.37-2.62; P=0.974). The SIG was significantly associated with higher risk of recurrence (hazard ratio[HR], 1.96; 95% CI, 1.08-3.57; P=0.027), expect the LIG (HR, 1.90; 95% CI, 0.95-3.77; P=0.068). There was no significant difference in OS among the three groups.
Conclusions
Time intervals 4-6 weeks had the higher pCR rates and better DFS, and longer than 6 weeks were associated with increasing surgical complexity. Patients meeting surgical indications should try to receive surgery within 4-6 weeks after NICT.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.