Evaluation of Pathologic Response in Lymph Nodes of Lung Cancer Patients Receiving Neoadjuvant Chemotherapy

Apar Pataer, Annikka Weissferdt, Ara A Vaporciyan, Arlene M Correa, Boris Sepesi, Ignacio I Wistuba, John V Heymach, Tina Cascone, Stephen G Swisher
Journal of Thoracic Oncology 2021 April 12

INTRODUCTION: Major pathologic response (MPR), defined as ≤10% residual viable tumor, currently serves as a surrogate endpoint for survival for patients with resectable non-small cell lung cancer (NSCLC) after neoadjuvant chemotherapy. However, the significance of pathologic response in lymph nodes harboring metastatic tumor in such patients remains uncertain. Therefore, we studied the effect of neoadjuvant chemotherapy on resected positive lymph nodes and determined if the degree of pathologic response in the lymph nodes alone (LN-MPR) or in combination with that of the primary tumor (PT-MPR) was able to predict outcome.

METHODS: Seventy-five NSCLC patients who underwent neoadjuvant chemotherapy and complete surgical resection were included in this study. Tissue specimens were retrospectively evaluated by two pathologists blinded to the patients' treatments and outcomes. Specimens were reviewed for the degree of pathologic response in the primary tumor and in any involved lymph nodes. The prognostic performance of LN-MPR alone or in combination with PT-MPR with respect to overall survival (OS) was examined using the Kaplan-Meier method and a Cox regression model.

RESULTS: LN-MPR was significantly predictive of long-term OS after neoadjuvant chemotherapy. A combination of PT-MPR with LN-MPR was significantly associated with outcome and allowed stratification of patients into 3 prognostic groups (p = 0.001).

CONCLUSIONS: LN-MPR in isolation is a reliable predictor of OS in NSCLC patients receiving neoadjuvant chemotherapy. A combination of LN-MPR with PT-MPR appears to correlate well with outcome and can be used to predict prognosis in this patient population.

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