In stage III non-small cell lung cancer (NSCLC), curative treatment approaches used to include neoadjuvant therapy followed by surgery, and definitive chemoradiotherapy followed by consolidation durvalumab (CRT-ICI). Surgical strategies included either neoadjuvant chemotherapy (CTx-surg) or chemoradiotherapy (CRT-surg). We studied the outcomes of these three radical intent strategies in the Netherlands Cancer Registry (NCR) for patients diagnosed from 2017 to 2021. Patients with clinical stage III NSCLC (TNM edition 8) were identified in the NCR after excluding patients with known driver mutations, ECOG performance status >=2, N3-disease and those undergoing sequential chemoradiotherapy or single modality/palliative treatments. Overall survival (OS) was calculated from date of surgery or start of durvalumab. Treatments delivered were CRT-ICI (n = 1016 patients), CRT-surg (n = 166) and CTx-surg (n = 111). The surgical series comprised 224 lobectomies, 21 bilobectomies and 32 pneumonectomies, with a 90-day postoperative mortality rate of 3.3 %. Use of CRT-surg decreased steeply after 2018, when durvalumab became fully reimbursed, and use of CRT-ICI increased. Three-year OS was better following CRT-surg (78.7 %) compared to CTx-surg (66.7 %) or CRT-ICI (63.2 %). After controlling for age, ECOG performance status and histology, the hazard ratios for CRT-surg and CTx-surg were 0.66 (95 % CI 0.47–0.91) and 0.82 (95 % CI 0.58–1.17), respectively, compared to CRT-ICI. Population survivals after curative strategies for clinical stage III NSCLC in The Netherlands exceed those reported historically for both surgical and non-surgical approaches. Use of surgery decreased from 2018 following the formal reimbursement of durvalumab. While variations in case-mix hamper comparison between curative treatment strategies, there is a clear need for randomized studies in subgroups with potentially resectable disease.

中文翻译：

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自 2017 年以来 III 期 NSCLC 根治性手术和非手术治疗后基于人群的生存率

在 III 期非小细胞肺癌 (NSCLC) 中，治愈性治疗方法包括新辅助治疗后手术，以及根治性放化疗后巩固度瓦鲁单抗 (CRT-ICI)。手术策略包括新辅助化疗（CTx-surg）或放化疗（CRT-surg）。我们研究了荷兰癌症登记处 (NCR) 2017 年至 2021 年诊断的患者的这三种激进意图策略的结果。在排除具有已知驱动突变的患者后，NCR 中确定了临床 III 期 NSCLC（TNM 第 8 版）患者， ECOG 体能状态 >=2、N3 疾病以及接受序贯放化疗或单一方式/姑息治疗的患者。总生存期 (OS) 从手术日期或度瓦鲁单抗开始计算。提供的治疗包括 CRT-ICI（n = 1016 名患者）、CRT-surg（n = 166）和 CTx-surg（n = 111）。手术系列包括 224 例肺叶切除术、21 例双叶切除术和 32 例全肺切除术，术后 90 天死亡率为 3.3%。 2018 年 durvalumab 完全报销后，CRT-surg 的使用急剧下降，而 CRT-ICI 的使用则有所增加。与 CTx-surg (66.7 %) 或 CRT-ICI (63.2 %) 相比，CRT-surg (78.7 %) 后的三年 OS 更好。控制年龄、ECOG 体能状态和组织学后，与 CRT-ICI 相比，CRT-surg 和 CTx-surg 的风险比分别为 0.66 (95% CI 0.47–0.91) 和 0.82 (95% CI 0.58–1.17)。 。荷兰临床 III 期非小细胞肺癌采用治疗策略后的人群生存率超过了历史上报告的手术和非手术方法的生存率。在 durvalumab 正式报销后，手术的使用量自 2018 年开始减少。虽然病例组合的差异阻碍了治疗策略之间的比较，但显然需要对具有潜在可切除疾病的亚组进行随机研究。