Lung Cancer Surgery after Treatment with Anti-PD1/PD-L1 Immunotherapy for Non-Small-Cell Lung Cancer: A Case—Cohort Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Study Population
3.2. Tumour Characteristics and Surgical Interventions
3.3. Surgical, Perioperative, and Pathological Outcomes
3.4. Clinical Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Total Population (n = 59) | ICI Group (n = 25) | Control Group (n = 34) | p |
---|---|---|---|---|
Age, years | 60.4 (56–67) | 60.0 (54.6–62.8) | 62.7 (57.6–67.7) | 0.26 |
BMI, kg/m2 | 24.7 ± 4.6 | 25.2 ± 4.7 | 24.3 ± 4.6 | 0.27 |
Gender | 0.98 | |||
Male, n (%) | 40 (67.8) | 17 (68.0) | 23 (67.6) | |
Female, n (%) | 19 (32.2) | 8 (32.0) | 11 (32.4) | |
Tobacco status | ||||
Active or former smoker, n (%) | 55 (93.2) | 23 (92.0) | 32 (94.2) | >0.99 |
Exposure, pack-years | 38.9 ± 16.0 | 37.8 ± 21.1 | 39.6 ± 11.3 | 0.51 |
Comorbidities | ||||
ASA score | 2 (2–3) | 2 (2–3) | 2 (2–3) | 0.70 |
COPD, n (%) | 25 (42.4) | 11 (44.0) | 14 (41.2) | 0.82 |
Asbestos exposure, n (%) | 9 (15.3) | 3 (12.0) | 6 (17.6) | 0.72 |
Other respiratory disease *, n (%) | 5 (8.5) | 3 (12.0) | 2 (5.9) | 0.64 |
Arterial hypertension, n (%) | 22 (37.3) | 10 (40.0) | 12 (35.3) | 0.79 |
Diabetes, n (%) | 5 (8.5) | 3 (12.0) | 2 (5.9) | 0.64 |
Dyslipidemia, n (%) | 12 (20.3) | 8 (32.0) | 4 (11.8) | 0.10 |
History of thoracic surgery, n (%) | 3 (5.1) | 1 (4.0) | 2 (5.9) | >0.99 |
Pulmonary function testing, n (%) | 59 (100) | 25 (100) | 34 (100) | - |
FEV1, L | 2.6 ± 0.7 | 2.5 ± 0.6 | 2.6 ± 0.8 | 0.73 |
FEV1, % predicted | 86.4 ± 16.7 | 85.5 ± 14.8 | 87.2 ± 18.2 | 0.76 |
FVC, L | 3.6 ± 0.9 | 3.6 ± 0.9 | 3.6 ± 0.9 | 0.78 |
FVC, % predicted | 99.7 ± 14.5 | 100.0 ± 14.3 | 99.5 ± 14.8 | 0.94 |
TLC, L | 6.43 ± 1.3 | 6.3 ± 1.4 | 6.6 ± 1.3 | 0.39 |
TLC, % predicted | 105.2 ± 14.9 | 105.2 ± 14.2 | 105.0 ± 15.7 | 0.89 |
FEV1/FVC, % | 69.2 ± 9.7 | 69.4 ± 8.7 | 69.1 ± 10.4 | 0.85 |
TLCO, % predicted | 64.7 ± 15.0 | 64.9 ± 15.8 | 64.6 ± 14.6 | 0.79 |
Exercise testing, n (%) | 27 (45.8) | 10 (40.0) | 17 (50.0) | 0.60 |
VO2 max, mL/kg/min | 17.7 ± 3.5 | 17.6 ± 2.1 | 17.8 ± 4.2 | 0.78 |
Pulmonary rehabilitation, n (%) | 21 (35.6) | 16 (64.0) | 12 (35.3) | 0.03 |
Histopathology | ||||
Adenocarcinoma, n (%) | 37 (62.7) | 18 (72.0) | 19 (55.9) | 0.39 |
Squamous cell carcinoma, n (%) | 20 (33.9) | 6 (24.0) | 14 (41.2) | |
Carcinoma NOS, n (%) | 2 (33.9) | 1 (4.0) | 1 (2.9) | |
PD-L1 expression available, n (%) | 40 (67.7) | 20 (80.0) | 20 (58.8) | 0.08 |
0% | 13 (22.0) | 3 (12.0) | 10 (29.4) | <0.01 |
1–49% | 6 (10.2) | 1 (4.0) | 5 (14.7) | |
≥50% | 18 (30.5) | 16 (64.0) | 5 (14.7) |
Variable | ICI Group (n = 25) | Control Group (n = 34) | p |
---|---|---|---|
Location of target lesion | 0.08 | ||
RUL, n (%) | 7 (28.0) | 15 (44.1) | |
LUL, n (%) | 11 (44.0) | 6 (17.6) | |
RLL, n (%) | 2 (8.0) | 8 (23.5) | |
LLL, n (%) | 5 (20.0) | 5 (14.7) | |
Topography | 0.38 | ||
Proximal (juxta-mediastinal), n (%) | 13 (52.0) | 17 (50.0) | |
Distal, n (%) | 11 (44.0) | 12 (35.2) | |
Sulcus tumour, n (%) | 1 (4.0) | 5 (14.7) | |
Size of target lesion on imaging * | |||
Baseline evaluation, mm | 58.6 ± 26.0 | 63.0 ± 25.9 | |
Preoperative evaluation, mm | 40.0 ± 21.8 | 44.3 ± 20.9 | |
Evolution, % | −33.3 (9.0–42.8) | −26.3 (10.7–40.6) | 0.56 |
Type of resection | 0.41 | ||
Single lobectomy, n (%) | 15 (60.0) | 21 (61.8) | |
Pneumonectomy, n (%) | 6 (24.0) | 10 (29.4) | |
Bilobectomy, n (%) | 2 (8.0) | 3 (8.8) | |
Segmentectomy, n (%) | 2 (8.0) | 0 | |
Surgical approach | 0.58 | ||
VATS only, n (%) | 11 (42.0) | 16 (47.1) | |
Thoracotomy, n (%) | 14 (58.0) | 18 (52.9) | |
Robot-assisted surgery, n (%) | 7 (28.0) | 5 (14.7) | |
Surgery setting | <0.005 | ||
After neoadjuvant treatment, n (%) | 7 (28.0) | 20 (58.8) | |
Downstaging, n (%) | 6 (24.0) | 5 (14.7) | |
Residual tumoral ablation, n (%) | 8 (32.0) | 1 (2.9) | |
Oligometastatic disease management, n (%) | 4 (16.0) | 8 (23.5) |
Variable | Preoperative ICI (n = 25) | Control (n = 34) | p |
---|---|---|---|
Surgical outcomes | |||
Operative time, min | 180.6 ± 54.6 | 192.8 ± 68.4 | 0.81 |
Conversion after VATS, n (%) | 6/17 (35.3) | 4/20 (20.0) | 0.46 |
Intraoperative mortality, n (%) | 0 | 0 | - |
Surgeon-reported difficulties | |||
Challenging dissection, n (%) | 7 (28.0) | 10 (29.4) | 0.91 |
Adhesions, n (%) | 15 (60.0) | 16 (47.1) | 0.73 |
Tissue fibrosis or inflammation, n (%) | 10 (40.0) | 1 (2.9) | <0.0004 |
Intraoperative vascular wound, n (%) | 3 (12.0) | 4 (11.8) | >0.99 |
Procedure adapted during surgery *, n (%) | 3 (12.0) | 2 (5.9) | 0.64 |
Perioperative outcomes | |||
Total hospital LOS, days | 7 (5–11) | 7 (6–9) | 0.74 |
ICU LOS, days | 1 (0–1] | 1 (0–2) | 0.79 |
90-day mortality, n (%) | 0 | 0 | - |
Perioperative complications—any grade | 12 (48.0) | 16 (47.1) | 0.94 |
Persistent air leak, n (%) | 4 | 6 | - |
Pneumonia, n (%) | 6 | 4 | - |
Recurrent nerve palsy, n (%) | 2 | 5 | - |
Respiratory failure, n (%) | 2 | 3 | - |
Persistent pleural effusion, n (%) | 2 | 0 | - |
Intrathoracic bleeding, n (%) | 1 | 3 | - |
Arrythmia, n (%) | 2 | 1 | - |
Atelectasis, n (%) | 0 | 3 | - |
Sepsis, n (%) | 1 | 1 | - |
Anastomosis failure, n (%) | 1 | 0 | - |
Acute urinary retention, n (%) | 0 | 1 | - |
Pathological outcomes | |||
R0 achieved, n (%) | 24 (96.0) | 31 (91.2) | 0.63 |
RVT present, n (%) | 18 (72.0) | 29 (85.2) | 0.33 |
Major pathological response °, n (%) | 12 (44.0) | 8 (23.5) | 0.05 |
pCR, n (%) | 7 (28.0) | 5 (14.7) | 0.21 |
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El Husseini, K.; Piton, N.; De Marchi, M.; Grégoire, A.; Vion, R.; Blavier, P.; Thiberville, L.; Baste, J.-M.; Guisier, F. Lung Cancer Surgery after Treatment with Anti-PD1/PD-L1 Immunotherapy for Non-Small-Cell Lung Cancer: A Case—Cohort Study. Cancers 2021, 13, 4915. https://doi.org/10.3390/cancers13194915
El Husseini K, Piton N, De Marchi M, Grégoire A, Vion R, Blavier P, Thiberville L, Baste J-M, Guisier F. Lung Cancer Surgery after Treatment with Anti-PD1/PD-L1 Immunotherapy for Non-Small-Cell Lung Cancer: A Case—Cohort Study. Cancers. 2021; 13(19):4915. https://doi.org/10.3390/cancers13194915
Chicago/Turabian StyleEl Husseini, Kinan, Nicolas Piton, Marielle De Marchi, Antoine Grégoire, Roman Vion, Pierre Blavier, Luc Thiberville, Jean-Marc Baste, and Florian Guisier. 2021. "Lung Cancer Surgery after Treatment with Anti-PD1/PD-L1 Immunotherapy for Non-Small-Cell Lung Cancer: A Case—Cohort Study" Cancers 13, no. 19: 4915. https://doi.org/10.3390/cancers13194915