Real-World Treatment Pathways in Stage III Non-Small-Cell Lung Cancer Surgical Patients in Portugal
DOI:
https://doi.org/10.82582/thorac.92Keywords:
Carcinoma, Non-Small-Cell Lung/therapy, Clinical Pathways, Neoplasm Staging, PortugalAbstract
Introduction: Stage III non-small-cell lung cancer (NSCLC) is a complex and heterogeneous disease, with no established optimal treatment sequence. We aimed to characterize surgically treated patients with stage III NSCLC in Portugal.
Methods: PICTuRE was a multicentric, retrospective study. Adults with stage III NSCLC diagnosed in 2018 were followed until disease progression, death, loss of follow-up, or end of study. Overall survival and disease-free survival were estimated using the Kaplan-Meier method.
Results: Of 278 patients included in PICTuRE, 59 (21.2%) underwent surgery. Surgical patients had a mean age of 65±9 years and were predominantly men (57.6%) and current/former smokers (79.3%). Most presented with adenocarcinoma (71.2%) and stage IIIA disease (79.7%), with ECOG 0-1. All patients underwent at least one non-invasive staging method, while 64.4% received minimally invasive/invasive staging. Lag-times from multidisciplinary team decision to surgery ranged from approximately 1 to 11 months. Neoadjuvant treatment was administered to 22 patients. Resection margins were available for 50 patients (84% R0; 16% R1/R2). Operative mortality and morbidity rates were 3.4% and 25.5%, respectively. Adjuvant treatment was administered to 87.7% of patients, primarily chemoradiotherapy (50%). Median disease-free survival was 22 months, while overall survival was not reached.
Conclusion: The real-world analysis of the surgical population in the Portuguese PICTuRE study highlights the complexity and heterogeneity of stage III NSCLC, as well as the ongoing challenges in disease management. Although some recommendations and algorithms for tumour staging exist, practices are not yet consensual, particularly for N2 patients, with few undergoing minimally invasive or invasive methods. No single optimal treatment strategy exists due to variability in tumour extension and nodal involvement; nonetheless, multimodality treatment, including neoadjuvant therapy followed by surgery and adjuvant therapy, may potentially improve survival outcomes. Optimal therapeutic strategy requires careful balancing of patient characteristics, treatment effectiveness and safety within an MDT in a timely process (i.e., reduced delays between diagnosis, staging and treatment initiation). This approach may ensure the delivery of tailored approaches and optimize outcomes for this population. Further studies should evaluate the impact of novel therapies, such as immunotherapy, on treatment patterns and patient outcomes in real-world settings.
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