Interpretation of the Society of Thoracic Surgeons expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HAN Yichao , FAN Jingyuan , DU Mingyuan , LI Tiancheng ,  LI Hecheng

Department of Thoracic Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China;

Corresponding author：

LI Hecheng, Email: lihecheng2000@hotmail.com

Keywords：

Lung cancer; surgery; resectability; perioperative therapy; adjuvant therapy; interpretation

DOI：

10.7507/1007-4848.202501006

Video：

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With the continuous advancements in immunotherapy and targeted therapy, the treatment management and surgical resection assessment of locally advanced lung cancer have undergone significant changes. In October 2024, the Society of Thoracic Surgeons (STS) released the "STS expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer", which provides the latest insights on the evaluation of resectability and multidisciplinary management of locally advanced lung cancer, neoadjuvant (including perioperative) therapy, and adjuvant therapy. This article aims to interpret this consensus, with the goal of introducing the latest perspectives of the STS consensus to thoracic surgeons and providing a reference for the rational implementation of surgical resection, multidisciplinary management, and standardized comprehensive treatment models for non-small cell lung cancer in China.

Citation： HAN Yichao, FAN Jingyuan, DU Mingyuan, LI Tiancheng, LI Hecheng. Interpretation of the Society of Thoracic Surgeons expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(4): 453-462. doi: 10.7507/1007-4848.202501006 Copy

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7. Cheng YF, Chen YL, Liu CC, et al. Adjuvant chemotherapy in pathological node-negative non-small cell lung cancer. Sci Rep, 2023, 13(1): 19137.
8. Sorin M, Prosty C, Ghaleb L, et al. Neoadjuvant chemoimmunotherapy for NSCLC: A systematic review and meta-analysis. JAMA Oncol, 2024, 10(5): 621-633.
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12. O'Brien M, Paz-Ares L, Marreaud S, et al. Pembrolizumab versus placebo as adjuvant therapy for completely resected stage ⅠB-ⅢA non-small-cell lung cancer (PEARLS/KEYNOTE-091): An interim analysis of a randomised, triple-blind, phase 3 trial. Lancet Oncol, 2022, 23(10): 1274-1286.
13. Felip E, Altorki N, Zhou C, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage ⅠB-ⅢA non-small-cell lung cancer (IMpower010): A randomised, multicentre, open-label, phase 3 trial. Lancet, 2021, 398(10308): 1344-1357.
14. Provencio M, Nadal E, Insa A, et al. Neoadjuvant chemotherapy and nivolumab in resectable non-small-cell lung cancer (NADIM): An open-label, multicentre, single-arm, phase 2 trial. Lancet Oncol, 2020, 21(11): 1413-1422.
15. Wakelee H, Liberman M, Kato T, et al. Perioperative pembrolizumab for early-stage non-small-cell lung cancer. N Engl J Med, 2023, 389(6): 491-503.
16. Glover J, Velez-Cubian FO, Toosi K, et al. Perioperative outcomes and lymph node assessment after induction therapy in patients with clinical N1 or N2 non-small cell lung cancer. J Thorac Dis, 2016, 8(8): 2165-2174.
17. Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage Ⅲ non-small-cell lung cancer: A phase Ⅲ randomised controlled trial. Lancet, 2009, 374(9687): 379-386.
18. Pless M, Stupp R, Ris HB, et al. Induction chemoradiation in stage ⅢA/N2 non-small-cell lung cancer: A phase 3 randomised trial. Lancet, 2015, 386(9998): 1049-1056.
19. van Meerbeeck JP, Kramer GW, Van Schil PE, et al. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage ⅢA-N2 non-small-cell lung cancer. J Natl Cancer Inst, 2007, 99(6): 442-450.
20. Detterbeck FC, Woodard GA, Bader AS, et al. The proposed ninth edition TNM classification of lung cancer. Chest, 2024, 166(4): 882-895.
21. Zhou Q, Pan Y, Yang X, et al. Neoadjuvant SHR-1701 with or without chemotherapy in unresectable stage Ⅲ non-small-cell lung cancer: A proof-of-concept, phase 2 trial. Cancer Cell, 2024, 42(7): 1258-1267.
22. Xia H, Zhang H, Ruan Z, et al. Neoadjuvant camrelizumab (an anti-PD-1 antibody) plus chemotherapy or apatinib (a VEGFR-2 inhibitor) for initially unresectable stage Ⅱ-Ⅲ non-small-cell lung cancer: A multicentre, two-arm, phase 2 exploratory study. Signal Transduct Target Ther, 2024, 9(1): 145.
23. De Leyn P, Dooms C, Kuzdzal J, et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2014, 45(5): 787-798.
24. Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e211S-e250S.
25. Darling GE, Li F, Patsios D, et al. Neoadjuvant chemoradiation and surgery improves survival outcomes compared with definitive chemoradiation in the treatment of stage ⅢA N2 non-small-cell lung cancer. Eur J Cardiothorac Surg, 2015, 48(5): 684-690.
26. McElnay PJ, Choong A, Jordan E, et al. Outcome of surgery versus radiotherapy after induction treatment in patients with N2 disease: Systematic review and meta-analysis of randomised trials. Thorax, 2015, 70(8): 764-768.
27. Stefani A, Alifano M, Bobbio A, et al. Which patients should be operated on after induction chemotherapy for N2 non-small cell lung cancer? Analysis of a 7-year experience in 175 patients. J Thorac Cardiovasc Surg, 2010, 140(2): 356-363.
28. Martins RG, D'Amico TA, Loo BW, et al. The management of patients with stage ⅢA non-small cell lung cancer with N2 mediastinal node involvement. J Natl Compr Canc Netw, 2012, 10(5): 599-613.
29. Betticher DC, Hsu Schmitz SF, Tötsch M, et al. Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage ⅢA pN2 non-small-cell lung cancer: A multicenter phase Ⅱ trial. J Clin Oncol, 2003, 21(9): 1752-1759.
30. Yang HX, Hou X, Lin P, et al. Survival and risk factors of surgically treated mediastinal invasion T4 non-small cell lung cancer. Ann Thorac Surg, 2009, 88(2): 372-378.
31. Lucchi M, Viti A, Melfi F, et al. ⅢB-T4 non-small cell lung cancer: Indications and results of surgical treatment. J Cardiovasc Surg (Torino). 2007, 48(3): 369-374.
32. Kumar A, Gandhi K, Gilja S, et al. Multimodal therapy for T4 N2 non-small cell lung cancer with additional ipsilateral pulmonary nodules. Ann Thorac Surg Short Rep, 2023, 1(4): 566-569.
33. Yamanashi K, Menju T, Hamaji M, et al. Prognostic factors related to postoperative survival in the newly classified clinical T4 lung cancer. Eur J Cardiothorac Surg, 2020, 57(4): 754-761.
34. Wang F, Su H, E H, et al. Reconsidering T component of cancer staging for T3/T4 non-small-cell lung cancer with additional nodule. Ther Adv Med Oncol, 2022, 14: 17588359221130502.
35. Le Pechoux C, Pourel N, Barlesi F, et al. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): An open-label, randomised, phase 3 trial. Lancet Oncol, 2022, 23(1): 104-114.
36. Li Q, Zhang P, Wang Y, et al. T4 extension alone is more predictive of better survival than a tumour size >7 cm for resected T4N0-1M0 non-small-cell lung cancer. Eur J Cardiothorac Surg, 2019, 55(4): 682-690.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of the Society of Thoracic Surgeons expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer

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