The following is a summary of “Surgery/non-surgery-based strategies for invasive locally advanced non-small cell lung cancer in the era of precision medicine,” published in the December 2024 issue of Surgery by Wang et al.
Treatment strategies for invasive T4 non-small cell lung cancer (NSCLC) are individualized and often involve a multidisciplinary team (MDT). Recent advances in precision medicine may offer new opportunities for these patients.
Researchers conducted a retrospective study to evaluate survival outcomes in patients with invasive T4 NSCLC across 3 periods of precision medicine.
They used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with T4 N 0-3 M0 NSCLC and central structure invasion (2010 to 2020). Propensity Score Matching (PSM) was employed to adjust for confounding variables and used competing risk regression models to analyze cancer-specific survival (CSS).
The results showed 9,106 cases, and median OS significantly improved with advancements in precision medicine, 23.0 months in Period I (2010-2014, 95% CI: 22.0 – 25.0), 28.0 months in Period II (2015-2017, 95% CI: 26.0 – 31.0), and was not reached (NR) in Period III (2018-2020, 95% CI: 30.0 – NR). Multivariate analysis revealed a continuous survival improvement from Period I to Period III (P<0.001). Surgery-based treatment showed the longest median OS at 46.0 months (95% CI: 43.0 – 49.0, P<0.001) compared with chemoradiotherapy, chemotherapy alone, and radiation alone. Surgery-based treatment also yielded the best survival in all 3 precision medicine eras across both N0-1 and N2-3 categories. After analyzing CSS, the results remained consistent. Survival following chemoradiotherapy and chemotherapy alone showed significant and progressive improvements across the three precision medicine periods, with no significant survival differences between Periods I and II among surgery-based patients. Still, a slight trend toward improvement was noted in Period III.
They concluded that advancements in precision medicine have led to improved survival for patients with invasive stage III NSCLC. Surgery-based treatments continue to provide substantial benefits across all periods.
Source: americanjournalofsurgery.com/article/S0002-9610(24)00684-6/abstract
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