What percentage of patients with Stage 3 Non-Small Cell Lung Cancer (NSCLC) undergo surgery?

From the Guidelines

Approximately 47.4% of patients with Stage 3 Non-Small Cell Lung Cancer (NSCLC) undergo surgery as part of their treatment, according to the most recent data from the National Cancer Center of China between 2005 and 2014 1. This percentage may vary based on several factors, including the specific stage (3A or 3B), the patient's overall health status, and the location and extent of the tumor.

Factors Influencing Surgical Intervention

• The decision for surgical intervention typically depends on whether complete tumor removal (R0 resection) is possible
• The patient's pulmonary function and ability to tolerate surgery
• The presence of comorbidities Many Stage 3 NSCLC patients receive multimodality treatment, combining surgery with chemotherapy, radiation therapy, or both (neoadjuvant or adjuvant therapy) 1. This approach aims to improve survival outcomes by addressing both local and systemic disease control. For patients who do not undergo surgery, definitive chemoradiation remains the standard treatment approach.

Treatment Approaches

• Neoadjuvant chemotherapy alone is the preferred treatment approach for some patients 1
• Neoadjuvant chemoradiation followed by surgery may represent a possible treatment option for well-selected patients who could undergo a lobectomy 1 It's worth noting that the application rate of video-assisted thoracoscopic surgery (VATS) has been increasing over the past decade, with an estimated adoption rate of up to 80% in Chinese patients with lung cancer between 2016 and 2019 1.

From the Research

Stage 3 NSCLC Treatment Options

• The treatment options for Stage 3 Non-Small Cell Lung Cancer (NSCLC) vary depending on the patient's overall health, the size and location of the tumor, and the extent of lymph node involvement.
• According to a study published in 2019 2, surgery may be associated with similar or worse short-term but improved long-term survival compared with chemoradiation in patients with clinical or pathologic stage N3 NSCLC.

Percentage of Patients Undergoing Surgery

• A study published in 2022 3 found that 56% of patients with stage IIIA/B-N2 NSCLC underwent a surgical strategy, while 44% underwent a medical strategy.
• Another study published in 2015 4 found that 1,714 patients (19% of the total study population) with clinical stage IIIB NSCLC underwent surgical intervention as part of their multimodality treatment.
• It's worth noting that the percentage of patients undergoing surgery may vary depending on the specific stage and characteristics of the disease, as well as the treatment center and multidisciplinary team involved in the patient's care.

Factors Influencing Treatment Decisions

• The decision to undergo surgery or other treatments for Stage 3 NSCLC is often made on a case-by-case basis, taking into account factors such as the patient's overall health, tumor size and location, and extent of lymph node involvement 3, 4.
• A study published in 2019 2 found that the complete resection rate was 80% and 73% for patients with clinical stage N3 and pathologic stage N3 disease, respectively.
• The reproducibility of treatment decision-making for Stage 3 NSCLC patients at a multidisciplinary tumor board was found to be moderate, with an overall concordance of 70% 3.