Impact of perioperative chemotherapy on survival outcomes in patients with non-small cell lung cancer undergoing pneumonectomy: a SEER database analysis

J Thorac Dis. 2026 Mar 31;18(3):232. doi: 10.21037/jtd-2026-1-0002. Epub 2026 Feb 25.

ABSTRACT

BACKGROUND: Pneumonectomy for locally advanced non-small cell lung cancer (NSCLC) carries significant risk. While perioperative chemotherapy is standard for multimodality treatment, its specific impact on long-term survival in this high-risk surgical cohort is not well-defined. This study aims to evaluate the impact of chemotherapy on long-term survival in patients with locally advanced NSCLC undergoing pneumonectomy.

METHODS: Data from 640 patients with T3-4N0-3M0 NSCLC who underwent pneumonectomy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (2007-2021). Patients were grouped by chemotherapy receipt and analyzed for the timing of chemotherapy. Propensity score matching (PSM) was applied to balance baseline differences. Survival outcomes were analyzed using Cox regression and subgroup interaction analyses.

RESULTS: A total of 640 patients met the inclusion criteria, of whom 390 (60.9%) received chemotherapy. The chemotherapy group was younger, had more advanced nodal disease, and higher radiotherapy rates (all P<0.001). After PSM, 204 patients were included in each group. Compared with surgery alone, chemotherapy was associated with significantly longer overall survival (OS) (median OS: 67.0 vs. 20.0 months, P<0.001). This association remained significant even after excluding patients who died within 90 days postoperatively [log-rank P=0.002, hazard ratio (HR) =0.722, 95% confidence interval (CI): 0.588-0.886]. Furthermore, chemotherapy remained an independent protective factor in multivariate analysis (HR =0.48, 95% CI: 0.39-0.60). The difference in efficacy between adjuvant and neoadjuvant chemotherapy was not statistically significant (P=0.07, HR =1.281, 95% CI: 0.976-1.683). Subgroup analysis revealed greater survival advantages in elderly patients (≥65 years).

CONCLUSIONS: Chemotherapy is associated with improved survival in locally advanced NSCLC after pneumonectomy. Neoadjuvant and adjuvant chemotherapy show comparable efficacy.

PMID:41988265 | PMC:PMC13077379 | DOI:10.21037/jtd-2026-1-0002