Major pathologic response predicts survival in resectable stage IIIA non-small cell lung cancer after neoadjuvant therapy

OBJECTIVES Major pathologic response is more common in survival analyses than pathological complete response. Whether major pathologic response can predict survival of patients with resectable stage IIIA non-small cell lung cancer and whether neoadjuvant chemotherapy or immunochemotherapy affect the prognosis of patients remains questionable.METHODS Patients with resectable stage IIIA non-small cell lung cancer receiving neoadjuvant chemotherapy (>= 2 cycles) with/without immunotherapy were enrolled and divided into two groups according to pathological response. Comparison between the two groups was through chi-square test. Univariate Cox regression analysis and log-rank test were made to identify predictive factors of overall survival and disease-free survival. Kaplan-Meier survival curves were constructed to evaluate the prognostic impact of these factors.RESULTS Totally, 38 patients were enrolled. Significant difference was observed in overall survival (P = 0.005) and disease-free survival (P = 0.007) between patients with/without major pathologic response. For patients failing to reach major pathologic response, those who underwent >= 2 cycles of neoadjuvant therapy exhibited improved outcomes in overall survival (P = 0.021) and disease-free survival (P = 0.046). Notably, within this subgroup, patients receiving >= 2 cycles of neoadjuvant immunochemotherapy showed a trend towards better overall survival (P = 0.076) and disease-free survival (P = 0.062).CONCLUSIONS Major pathologic response can predict survival of patients with resectable stage IIIA non-small cell lung cancer. For patients potentially not achieving major pathologic response after two cycles of neoadjuvant therapy, extended cycles of feasible neoadjuvant therapy are advisable for survival benefits. Non-small cell lung cancer (NSCLC) is the leading subtype, accounting for around 80%-85%, of lung cancer [1].