Surgery for Pancoast Tumors in Multimodality Setting: Analysis of Outcomes and Risk Factors

TL;DR

This study examines the outcomes of surgery for Pancoast tumors after chemoradiotherapy, identifying factors that affect survival and recurrence.

Contribution

The study provides insights into prognostic factors and outcomes for Pancoast tumor patients treated with trimodal therapy at a high-volume center.

Findings

Median overall survival was 37 months with 1-, 3-, and 5-year survival rates of 71%, 52%, and 41%.

Pathological complete response and vertebral/vascular infiltration significantly influenced recurrence and mortality.

Trimodal therapy remains the best treatment for Pancoast tumors, with potential for improvement through new therapies.

Abstract

Background: Pancoast tumors are a rare subset of lung cancers that require a multimodal approach (induction chemoradiotherapy and surgery), best performed in highly specialized centers. This study analyzes the outcomes and prognostic factors in patients treated at a high-volume center over an extended period. Methods: We retrospectively reviewed 43 patients who underwent surgery for Pancoast tumors, following induction treatment between 2005 and 2023. Survival was estimated using the Kaplan–Meier method, and a Cox proportional hazards model was applied to identify prognostic factors (significance level p = 0.05). Results: The median patient age was 63 years, with over 90% having a disease at stage III or higher. Induction chemoradiotherapy was administered to 79% of the patients, achieving a pathological complete response (PCR) in 23% of the patients. The median overall survival (OS) was 37 months, with 1–3 and 5-year OS rates of 71%, 52%, and 41%, respectively. The median disease-free survival (DFS) was 38 months, with 1-, 3-, and 5-year DFS rates of 72%, 62%, and 35%, respectively. A pathological complete response (PCR) and vertebral and/or vascular infiltration significantly influenced recurrence and mortality risk. Conclusions: Trimodal therapy still offers the best short- and long-term outcomes in patients with Pancoast tumors. Future strategies incorporating tyrosine kinase inhibitors and anti-PD1/PD-L1 may improve outcomes for patients by increasing PCR rates and improving disease control.

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