• Whitney S Brandt, Wanpu Yan, Jian Zhou, Kay See Tan, Joseph Montecalvo, Bernard J Park, Prasad S Adusumilli, James Huang, Matthew J Bott, Valerie W Rusch, Daniela Molena, William D Travis, Mark G Kris, Jamie E Chaft, and David R Jones.
• Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
• J. Thorac. Cardiovasc. Surg. 2019 Feb 1; 157 (2): 743-753.e3.

ObjectiveComparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non-small cell lung cancer has not been extensively studied.MethodsPatients with cT2-4N0-1M0 non-small cell lung cancer who received platinum-based chemotherapy were retrospectively identified. Exclusion criteria included stage IV disease, induction radiotherapy, and targeted therapy. The primary end point was disease-free survival. Secondary end points were overall survival, chemotherapy tolerance, and ability of Response Evaluation Criteria In Solid Tumors response to predict survival. Survival was estimated using the Kaplan-Meier method, compared using the log-rank test and Cox proportional hazards models, and stratified using matched pairs after propensity score matching.ResultsIn total, 330 patients met the inclusion criteria (n = 92/group after propensity-score matching; median follow-up, 42 months). Five-year disease-free survival was 49% (95% confidence interval, 39-61) for neoadjuvant chemotherapy versus 48% (95% confidence interval, 38-61) for adjuvant chemotherapy (P = .70). On multivariable analysis, disease-free survival was not associated with neoadjuvant chemotherapy or adjuvant chemotherapy (hazard ratio, 1.1; 95% confidence interval, 0.64-1.90; P = .737), nor was overall survival (hazard ratio, 1.21; 95% confidence interval, 0.63-2.30; P = .572). The neoadjuvant chemotherapy group was more likely to receive full doses and cycles of chemotherapy (P = .014/0.005) and had fewer grade 3 or greater toxicities (P = .001). Response Evaluation Criteria In Solid Tumors response to neoadjuvant chemotherapy was associated with disease-free survival (P = .035); 15% of patients receiving neoadjuvant chemotherapy (14/92) had a major pathologic response.ConclusionsTiming of chemotherapy, before or after surgery, is not associated with an improvement in overall or disease-free survival among patients with cT2-4N0-1M0 non-small cell lung cancer who undergo complete surgical resection.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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