Remote results of treatment of patients of the Russian population with stage I–II non-small cell lung cancer (results of the observational study CARL-001)

Introduction. This paper examines the treatment outcomes for patients with stage I and II non-small cell lung cancer (NSCLC) in real clinical practice. The frequency of molecular genetic testing of operated patients was determined, and long-term prognoses for the disease were determined depending on the volume of treatment.

Aim. To determine the effect of adding adjuvant treatment to radical surgery on the treatment outcomes in real clinical practice – overall and relapse-free survival. To determine the frequency and results of molecular genetic testing in patients with stage I–II NSCLC.

Materials and methods. The results were obtained during the study – clinical approbation of lung cancer (CARL-001). The study included 401 patients with stage I–IIB NSCLC. The study included 129 women and 272 men. The median age was 56 years. There were 272 patients with stage I disease, 129 with stage II. 83 patients received combined treatment, 318 patients received only surgical treatment. The median follow-up was 36 months.

Results. PD-L1 testing was performed in 31.7% of patients with stage II and in 14% of patients with stage I. The frequency of testing for mutations in the EGFR and ALK genes was 53.6% and 17.0% for stage II and 46% and 14.8% for stage I, respectively. Three-year overall survival of patients with stage IIA and adjuvant chemotherapy was higher compared to stage IIA patients who did not receive adjuvant treatment – 65% vs 69.24%. A similar indicator in patients with stage IIB also showed an advantage from adjuvant treatment 57.69% vs 72.86% in favor of those who received adjuvant. In patients with stage IIA and adjuvant therapy, 3-year relapse-free survival was 53.86% versus 50.0% without adjuvant. Among patients with stage IIB, the same parameter was 53.85% in the group without adjuvant versus 65.71% in the group that received adjuvant therapy.

Conclusions. Adjuvant polychemotherapy in patients with stage II disease has a positive effect on long-term treatment outcomes in the form of increased overall and relapse-free survival compared to patients with a similar stage of the disease without adjuvant treatment. Molecular genetic testing of patients with NSCLC allows us to identify the presence of activating mutations and PD-L1 expression, which is important information for planning further treatment tactics.

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