Surgery After Induction Immuno-Chemotherapy in Stage III-N3 Non-Small Cell Lung Cancer: A Single-Centre Retrospective Cohort Study

OBJECTIVES: The goal of this study was to preliminarily evaluate the efficacy of a surgical procedure following induction immuno-chemotherapy and nodal downstaging in patients with stage III-N3 non-small cell lung cancer (NSCLC). METHODS: A retrospective analysis was conducted on patients with stage III-N3 NSCLC who received induction immuno-chemotherapy at Shanghai Pulmonary Hospital from August 2019 to May 2023. Patients who achieved confirmed N3 lymph node downstaging, had resectable tumours, and maintained adequate performance status subsequently underwent a surgical procedure after induction therapy. In this post-induction comparative analysis, baseline characteristics and oncological outcomes were compared between patients who underwent surgical procedures and those who did not. RESULTS: After induction therapy, 28 (24.6%) patients underwent a surgical procedure, while 78 (73.6%) did not. The patients in the surgical group were younger (P = .012), had a higher body mass index (P = .032), and exhibited a higher proportion of contralateral mediastinal or hilar lymph node involvement (P = .024). Compared with those who did not undergo a surgical procedure, patients who did undergo a surgical procedure showed better progression-free survival (hazard ratio [HR] = 0.46, 95% CI, 0.23-0.92) and overall survival (HR = 0.31, 95% CI, 0.11-0.88). However, in the biopsy subgroup, patients who underwent a surgical procedure had better overall survival (HR = 0.64, 95% CI, 0.19-2.20) but similar progression-free survival (HR = 0.97, 95% CI, 0.42-2.23) compared with those who did not undergo a surgical procedure. CONCLUSIONS: These real-world findings provide early positive signals that a surgical procedure after induction immuno-chemotherapy may be feasible in carefully selected patients with stage III-N3 NSCLC.