Lung resection after initial nonoperative treatment for non–small cell lung cancer

Objectives To assess the outcomes of lung resection in patients with non-small cell lung cancer (NSCLC) previously treated with nonoperative treatment and to identify prognostic factors associated with survival. Methods Patients who underwent surgery (2010-2022) after initial nonoperative treatment at a single institution were identified from a prospectively maintained database. Exclusion criteria included metachronous cancer, planned neoadjuvant therapy, and surgery for diagnostic or palliative indications. Cox models were constructed for overall survival (OS) and event-free survival (EFS). Survival of stage IV patients was compared with survival of a non-study cohort who did not undergo surgery. Results In total, 120 patients met the inclusion criteria. Initial clinical stage was early stage in 16%, locoregionally advanced in 25%, and metastatic in 59% of patients. The indication for surgery was recurrence in 18%, local persistent disease in 23%, oligoprogression in 22%, and local control of oligometastatic disease in 38% of patients. Grade ≥3 complications occurred in 5% of patients; 90-day mortality was 3%. Three-year EFS and OS were 39% and 73%, respectively. Male sex and lymphovascular invasion were associated with shorter EFS and OS; younger age and prior radiation therapy were associated with shorter OS. Stage IV patients who received salvage lung resection had better OS than similar patients who received subsequent systemic therapy and no surgery. Conclusions In this selected, heterogeneous population, lung resection after initial nonoperative treatment for NSCLC was safe. Surgery as local consolidative therapy was associated with encouraging outcomes and should be considered for these patients.