Abstract 220P
Background
Locally advanced NSCLC is a heterogeneous disease, encompassing a broad spectrum of tumor size and nodal involvement. Until recently, treatment for stage III NSCLC focused on a combination of surgery, chemotherapy, and radiotherapy. However, the advent of immunotherapy and targeted therapies based on molecular profiling has expanded treatment options. The study aims to evaluate survival outcomes of operated stage III NSCLC as part of a multimodal approach.
Methods
This retrospective single-center cohort analysis reviewed patients with stage IIIA and IIIB NSCLC who underwent surgery between 2018 and 2024 (8th TNM).
Results
136 patients were identified, predominantly male (64.7%), with a mean age of 66.2 ± 10.4 years, and 79.7% had a smoking history. Mediastinal staging was completed in 77.9%. Neoadjuvant treatment was performed in 16 patients (11.8%), mostly chemotherapy (12), but also chemoimmunotherapy (3) and chemoradiotherapy (1). Lobectomy was the preferred surgical procedure (88.2%), with adenocarcinoma being the predominant histologic subtype (68.4%). 93.4% achieved negative margins (R0). In final histopathology, stage IIIA was observed in 75.7% and stage IIIB in 23.5%. One patient had complete tumor remission (ypT0N0) after chemoimmunotherapy. Malignant upstaging was 61.8%. Adjuvant therapy was given to 81.6%, mainly chemotherapy (71), chemoradiotherapy (34), and radiotherapy (6), with 10 patients receiving adjuvant immunotherapy and 3, adjuvant TKI. Mean follow-up time was 23.7 ± 19.0 months. Recurrence was observed in 26.5% of patients, with lung and brain as the most common sites. Disease-free survival rate was 76.2% at 1-year and 56.3% at 3 and 5-years. Overall survival was 85.6% at 1 year, 70.3% at 3 years, and 67.4% at 5 years. Statistical analysis showed that DFS and OS correlated with stage.
Conclusions
Stage III NSCLC poses significant treatment challenges, highlighting the need for a clearer definition of the role of surgery, within multimodal treatment. A multidisciplinary approach, integrating immunotherapy and emerging targeted therapies, is essential to tailor the most effective treatment strategy for each individual patient.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.