Long-term survival results of non-small cell lung cancer patients with complete pathological response after neoadjuvant therapy

Background: This study aims to evaluate survival and recurrence rates in pT0/T1N0/M0 non-small cell lung cancer patients who underwent surgical resection after chemotherapy and/or radiotherapy, and investigate the role of positron emission tomography/computed tomography in preoperative evaluation. Methods: A total of 54 patients (52 males, 2 females; mean age 59.2±9.3 years; range 42 to 77 years) with locally advanced non-small cell lung cancer without lymph node metastasis who had induction therapy and were proven to be pT0N0 ( n=25) a nd pT1N0 (n=29) after pulmonary resection were included in the study. Patients were evaluated with thoracic computed tomography, bronchoscopy, respiratory function tests, and 18 patients with positron emission tomography/computed tomography, additionally. Those considered to be unresectable were clinically staged according to radiological findings. Invasive staging methods including transbronchial needle aspiration biopsy, mediastinoscopy, and video-assisted thoracoscopic surgery were performed for histological confirmation in those with resectable disease and N2 findings. Results: Mean follow-up duration was 34.8 months. Mean survival duration and five-year survival rates were 90.8 months and 86.3% in T0 patients and 62.6 months and 53.7% in T1 patients, respectively. Recurrence rates were significantly lower in T0 patients (p=0.03). Sensitivity, specificity, positive predictive value, and negative predictive value of preoperative positron emission tomography/computed tomography were 78%, 56%, 64%, and 71%, respectively. Negative predictive value in T0 and positive predictive value in T1 patients was 100%. Accuracy values in T0 and T1 patients (56% and 78%, respectively) were similar (p=0.3). Conclusion: Survival rates in pT0 and pT1 non-small cell lung cancer patients, who underwent lung resection after chemotherapy and/or radiotherapy, were similar with those of early stage patients who underwent surgery without induction therapy. Accuracy value of positron emission tomography/computed tomography in determining the presence of viable tumor cells was lower than expected.