Abstract 221P
Background
Around 20–30% of NSCLC cases are diagnosed at stage III, with an average survival of 12–24 months. This heterogeneous group lacks clearly defined treatment strategies. Current guidelines recommend a multimodal approach, but adjuvant therapy (AT) is often missed. Few studies have examined factors predicting the likelihood of initiating and completing AT. This study aims to explore these gaps and provide insights into AT adherence, crucial for future perioperative therapies with immune checkpoint inhibitors.
Methods
Approved by the local ethics committee (BO-EK-485112023), this retrospective study analyzed N2 NSCLC patients who underwent curative-intent resection at Lung Center Coswig (2015–2022). Clinicopathological and follow-up data were collected. Patients were grouped by AT into four groups: no AT, chemotherapy (CT), radiotherapy (RT) or combined therapy (CT+RT). Statistical analysis included regression analysis, t-tests, one-way ANOVA and Kaplan-Meier survival curves (P < 0.05 significant).
Results
79 patients (65.8% male, median age 64.5 years, 65.3% nonsquamous histology) with pathologically confirmed N2 metastatic NSCLC underwent curative surgery; 62.03% were preoperatively diagnosed with N2 disease. Of 68 patients (86.1%) starting adjuvant therapy, 7 received CT, 26 RT and 35 CT+RT. 11 Patients did not receive AT. The main reason for not initiating therapy was patient refusal (5 cases), followed by comorbidities and early progression. Therapy discontinuation occurred in 19.0%, highest in the CT group (42.9%). During follow-up, 58.2% experienced recurrence, and 43.0% died, with DFS of 30.4 months and OS of 44.2 months. No clinical, pulmonary, or serological parameters predicted therapy discontinuation. Among therapy subgroups, CT+RT showed the best OS and DFS. In this group, higher BMI positively impacted OS (P***) and DFS (P**), while elevated creatinine negatively affected OS (P**) and RFS (P*).
Conclusions
This study identified no significant risk factors for AT discontinuation in N2-metastasized patients undergoing curative surgery. RT alone had the highest compliance, while CT+RT achieved the best OS and RFS. Higher BMI appeared to confer a survival advantage in the CT+RT group.
Legal entity responsible for the study
R.S. Decker.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.