Is pneumonectomy appropriate after chemoimmunotherapy? Outcomes of neoadjuvant chemoimmunotherapy followed by pneumonectomy in the United States.
- 1Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
- 2Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Conn.
Abstract
Objective
The appropriateness of pneumonectomy for non-small cell lung cancer after neoadjuvant therapy is not well characterized, and there is concern for substantially greater mortality on the basis of results of trials such as Intergroup-0139. Here, we present current use and outcomes of pneumonectomy after neoadjuvant chemoimmunotherapy.Methods
Using the National Cancer Database, we identified and included adults with clinical stage I-III lung adenocarcinoma or squamous cell carcinoma who were diagnosed between 2018 and 2023 and treated with neoadjuvant chemoimmunotherapy followed by lobectomy or pneumonectomy. Three-year overall survival was assessed by Kaplan-Meier. Propensity matching and Cox proportional hazards models were based on patient and tumor characteristics.Results
The study included 2703 (94%) lobectomies and 173 (6%) pneumonectomies. Patients who underwent pneumonectomy had a more advanced T stage (64% vs 47% T3+, P < .001) but a lower comorbidity burden (71% vs 58% Charlson-Deyo of 0, P = .01). They had greater rates of 30-day unplanned readmission (9% vs 4%, P = .001) and R1+ resection (7.1% vs 3.9%, P = .046) but comparable 90-day mortality (<4.5% vs 2%, P = .24). Unadjusted 3-year overall survival was not significantly different between the 2 groups: 80% for pneumonectomy and 82% for lobectomy (P = .08). Similar trends were observed after propensity-matching for patient and tumor characteristics: 79% for pneumonectomy and 78% for lobectomy (P = .19). On Cox models, pneumonectomy was associated with a greater hazard ratio of mortality, but this was not statistically significant (odds ratio, 1.56; 95% CI, 0.91-2.68; P = .09).Conclusions
Pneumonectomy after induction chemoimmunotherapy demonstrated comparable early survival with lobectomy among selected patients in the United States. Use of pneumonectomy after chemoimmunotherapy in appropriate candidates appears reasonable.
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BibTeX
@article{caturegli2026pneumonectomy,
title = {{Is pneumonectomy appropriate after chemoimmunotherapy? Outcomes of neoadjuvant chemoimmunotherapy followed by pneumonectomy in the United States.}},
author = {Giorgio Caturegli and Ebony Jernigan and Maureen Canavan and Abigail Lynch and Ryan Kramer and Jayaditya Patil and Gabriela Esnaola and Daniel J Boffa and Benjamin J Resio},
journal = {JTCVS open},
year = {2026},
month = aug,
doi = {10.1016/j.xjon.2026.102047},
url = {https://europepmc.org/article/MED/42948574},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Is pneumonectomy appropriate after chemoimmunotherapy? Outcomes of neoadjuvant chemoimmunotherapy followed by pneumonectomy in the United States.
AU - Giorgio Caturegli
AU - Ebony Jernigan
AU - Maureen Canavan
AU - Abigail Lynch
AU - Ryan Kramer
AU - Jayaditya Patil
AU - Gabriela Esnaola
AU - Daniel J Boffa
AU - Benjamin J Resio
PY - 2026
DA - 2026/08/11
JO - JTCVS open
DO - 10.1016/j.xjon.2026.102047
UR - https://europepmc.org/article/MED/42948574
AB - Objective The appropriateness of pneumonectomy for non-small cell lung cancer after neoadjuvant therapy is not well characterized, and there is concern for substantially greater mortality on the basis of results of trials such as Intergroup-0139. Here, we present current use and outcomes of pneumonectomy after neoadjuvant chemoimmunotherapy.Methods Using the National Cancer Database, we identified and included adults with clinical stage I-III lung adenocarcinoma or squamous cell carcinoma who were diagnosed between 2018 and 2023 and treated with neoadjuvant chemoimmunotherapy followed by lobectomy or pneumonectomy. Three-year overall survival was assessed by Kaplan-Meier. Propensity matching and Cox proportional hazards models were based on patient and tumor characteristics.Results The study included 2703 (94%) lobectomies and 173 (6%) pneumonectomies. Patients who underwent pneumonectomy had a more advanced T stage (64% vs 47% T3+, P < .001) but a lower comorbidity burden (71% vs 58% Charlson-Deyo of 0, P = .01). They had greater rates of 30-day unplanned readmission (9% vs 4%, P = .001) and R1+ resection (7.1% vs 3.9%, P = .046) but comparable 90-day mortality (<4.5% vs 2%, P = .24). Unadjusted 3-year overall survival was not significantly different between the 2 groups: 80% for pneumonectomy and 82% for lobectomy (P = .08). Similar trends were observed after propensity-matching for patient and tumor characteristics: 79% for pneumonectomy and 78% for lobectomy (P = .19). On Cox models, pneumonectomy was associated with a greater hazard ratio of mortality, but this was not statistically significant (odds ratio, 1.56; 95% CI, 0.91-2.68; P = .09).Conclusions Pneumonectomy after induction chemoimmunotherapy demonstrated comparable early survival with lobectomy among selected patients in the United States. Use of pneumonectomy after chemoimmunotherapy in appropriate candidates appears reasonable.
SN - 2666-2736
ER -