Abstract 212P
Background
Neoadjuvant therapy followed by surgery is a common treatment strategy for locally advanced resectable non-small cell lung cancer (NSCLC), with approximately 20%–40% of patients achieving pathological complete response (pCR). While pCR is associated with improved prognosis, recurrence can still occur. This study investigates the clinical outcomes and recurrence patterns of NSCLC patients who achieved pCR after neoadjuvant therapy and surgery.
Methods
This retrospective cohort study was conducted across 8 nationwide institutions. From January 2018 to December 2023, patients with stage IIA to IIIC NSCLC (8th TNM stage) who achieved pCR after neoadjuvant treatment and surgery were included. Clinical characteristics, recurrence outcomes, and recurrence sites were assessed and compared with the number of neoadjuvant therapy cycles and the extent of mediastinal lymph node dissection.
Results
A total of 19 patients experienced recurrence among those who achieved pCR after receiving neoadjuvant therapy followed by surgery. Specifically, local recurrence occurred in 12 cases, distant recurrence in 10 cases. Among them, 3 patients died due to disease progression. In patients receiving neoadjuvant immunotherapy, 78.6% (11/14) experienced locoregional recurrence, and 42.9% (6/14) experienced distant recurrence. Among patients receiving at least three cycles of neoadjuvant therapy, 90.9% (10/11) had local recurrence, while 36.4% (4/11) had distant recurrence. The median time to locoregional recurrence was longer than that to distant recurrence [12.0 months (7.2–18.5) vs. 9.5 months (4.7–27.0)]. All patients underwent lobectomy and R0 resection. There were no differences in the extent of mediastinal lymph node dissection (N1, N2 and No.7 lymph nodes) among patients with different types of recurrence.
Conclusions
Patients with NSCLC achieving pCR may still experience relapse, indicating the necessity for stricter monitoring of high-risk patients. Patients receiving at least three cycles of neoadjuvant immunotherapy demonstrated a significantly reduced rate of distant recurrence, suggesting that additional neoadjuvant immunotherapymay lower the risk of postoperative recurrence.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.