Neoadjuvant chemotherapy with surgery versus concurrent chemoradiation in N2 non-small cell lung cancer: a retrospective comparative analysis of treatment outcomes

Öz

Aim: The most effective management approach for non–small cell lung cancer (NSCLC) patients presenting with mediastinal (N2) lymph node involvement has not yet been clearly established. This study compared clinical outcomes between neoadjuvant chemotherapy followed by surgical resection (NACTx-Surgery) and definitive concurrent chemoradiation (CRT) in patients with N2 disease. Methods: In this retrospective cohort analysis, we evaluated 61 individuals diagnosed with N2 stage NSCLC who received treatment at two high level tertiary care institutions. Thirty one patients received NACTx-surgery, and 30 patients received definitive CRT. Overall survival (OS), event free survival (EFS), and prognostic factors were compared using Kaplan-Meier analysis and Cox proportional hazards modeling. Results: The NACTx-surgery group achieved significantly superior median OS (37.9 months vs. 26.8 months; p=0.031) compared with the CRT group. EFS showed a trend toward improvement with NACTx-surgery (median 21.4 months vs. 13.9 months; p=0.052). TNM stage emerged as an independent predictor of EFS in multivariable analysis (HR 0.48; p=0.03). Recurrence occurred in 54.8% of NACTx-surgery patients and 70.0% of CRT patients. Conclusions: For appropriately selected patients with resectable N2 NSCLC, multimodal NACTx-surgery approaches achieved superior survival outcomes compared with definitive CRT. These findings support aggressive pursuit of resectability assessment and multimodal therapeutic planning. Future prospective randomized trials comparing contemporary NACTx-surgery with modern CRT plus consolidation immunotherapy are needed.

Anahtar Kelimeler

• N2 lymph node disease
• mediastinal involvement
• neoadjuvant chemotherapy
• surgical resection
• concurrent chemoradiation
• overall survival
• event free survival
• prognostic factors

N2 lenf nodu tutulumu olan küçük hücreli dışı akciğer kanserinde neoadjuvan kemoterapi sonrası cerrahi ile eşzamanlı kemoradyoterapinin karşılaştırılması: Tedavi sonuçlarının retrospektif analizi

Öz

Amaç: Mediastinal (N2) lenf nodu tutulumu olan küçük hücreli dışı akciğer kanseri (KHDAK) hastalarında optimal tedavi stratejisi henüz yeterince tanımlanmamıştır. Bu çalışma, N2 hastalığı olan hastalarda neoadjuvan kemoterapi sonrası cerrahi rezeksiyonu (NAKT-Cerrahi) ile definitif eşzamanlı kemoradyoterapiyi (KRT) karşılaştırmıştır. Gereç ve Yöntemler: Bu retrospektif kohort çalışması iki onkoloji merkezinde tedavi gören N2 KHDAK'li 61 hastayı analiz etmiştir. Otuz bir hasta NAKT sonrası cerrahi aldı, 30 hasta ise definitif KRT aldı. Genel sağkalım (OS), nüks/progresyonsuz sağkalım (EFS) ve prognostik faktörler Kaplan Meier analizi ve Cox orantılı hazard modellemesi kullanılarak karşılaştırıldı. Sonuçlar: NAKT Cerrahi grubu KRT grubuna kıyasla anlamlı şekilde daha yüksek median OS (37,9 ay'a karşı 26,8 ay; p = 0,031) elde etmiştir. Nüks/progresyonsuz sağkalım NAKT- Cerrahi yaklaşımında iyileşme eğilimi göstermiştir (median 21,4 ay'a karşı 13,9 ay; p = 0,052). Multivariable analizde TNM evresi EFS'nin bağımsız belirleyicisi olarak ortaya çıkmıştır (HR 0,48; p = 0,03). Nüks/progresyon NAKT-Cerrahi hastalarının %54,8'inde ve KRT hastalarının %70,0'ında görülmüştür. Sonuçlar: Rezektabl N2 KHDAK'li uygun seçilmiş hastalar için multimodal NAKT-Cerrahi yaklaşımları definitif KRT'ye kıyasla daha iyi sağkalım sonuçları sağlamıştır. Bu bulgular rezektabilite değerlendirmesinin agresif şekilde takip edilmesini ve multimodal terapötik planlamayı desteklemektedir. Çağdaş NAKT-Cerrahi ile modern KRT artı konsolidasyon immünoterapisini karşılaştıran prospektif randomize çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• N2 lenf nodu hastalığı
• mediastinal tutulum
• neoadjuvan kemoterapi
• cerrahi rezeksiyon
• eşzamanlı kemoradyoterapi
• genel sağkalım
• olaysız sağkalım
• prognostik faktörler

Kaynakça

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