Adjuvant Chemotherapy Following Neoadjuvant Therapy and Surgery for Non-small Cell Lung Cancer

BACKGROUND There is a dearth of data on outcomes of postoperative chemotherapy after neoadjuvant therapy followed by surgery in patients with locally advanced non-small cell lung cancer (NSCLC). The objective of this study is to compare survival outcomes in patients who did and did not receive adjuvant chemotherapy. METHODS A retrospective chart review was performed using our multicenter database to identify patients who received neoadjuvant therapy followed by surgery for clinical T3N0 or N1-N2 resectable NSCLC between 2011 and 2016. Survival outcomes were analyzed with the Kaplan-Meier method and a Cox proportional hazard model. Propensity score matching (PSM) was used to control for selection bias in evaluation of overall survival and recurrence-free survival by matching age, gender, smoking history, Charlson comorbidity index, histology, pathological nodal status and stage. RESULTS The subjects were 156 patients with a median age of 65 years. The median recurrence-free survival of the whole cohort was 66.3 months and overall survival was not reached. Before PSM, patients receiving adjuvant chemotherapy had significantly shorter recurrence-free survival (HR: 1.79, 95% CI: 1.13–2.82) and showed a trend for shorter overall survival (HR: 1.37, 95% CI: 0.78–2.39). After PSM, 50 patients were used for comparison in each group and those receiving adjuvant chemotherapy did not have a more favorable recurrence-free survival (HR: 1.33, 95% CI: 0.75–2.34) or overall survival (HR: 1.25, 95% CI: 0.62–2.51). CONCLUSIONS Adjuvant chemotherapy was not associated with favorable survival outcomes in patients treated with surgery following neoadjuvant therapy for locally advanced NSCLC.