# 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.

## Key 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.