What question did this study set out to answer?

This study aims to evaluate staging accuracy and treatment outcomes in stage III non-small cell lung cancer patients.

March 21, 2026Open Access

314P Natural language processing-based model to predict radiation pneumonitis in patients with locally advanced non-small cell lung cancer undergoing chemoradiotherapy

RVR. VeluswamyNYU Langone Health NTNicole TignorIcahn School of Medicine at Mount Sinai JBJ. BloomIcahn School of Medicine at Mount Sinai

Key Points

This study aims to evaluate staging accuracy and treatment outcomes in stage III non-small cell lung cancer patients.
Analyzed data from Baden-Wurttemberg Cancer Registry involving 10,700 adults diagnosed with NSCLC.
Examined two cohorts: patients with primary surgery and those receiving chemoradiotherapy with durvalumab.
Endpoints included overall survival and time to progression.
Only 42% agreement between clinical and pathological staging was found in patients with initial surgery.
Adjuvant platinum therapy improved overall survival compared to surgery alone.
Durva maintenance significantly benefited patients receiving chemoradiotherapy.

Abstract

Background: Stage III NSCLC represents a heterogeneous disease.Platinum-based chemotherapy remains the corner stone.Accurate staging is essential; however, any substantial discordance between clinical and pathological staging may affect treatment allocation and outcome.This study uses real-world data from the Baden-Wrttemberg Cancer Registry (BWCR) to characterize staging accuracy in operated patients and outcomes of major curative-intent treatments in stage III NSCLC.Methods: We identified 10,700 adults with non-metastatic NSCLC diagnosed 2017-2024 who received treatment in curative intent.Two cohorts were analyzed: 1) Primary surgery with pathological stage III (pIII, n = 1010), 2) Definitive chemoradiotherapy (RCT) durvalumab (Durva) with clinical stage III (cIII, n = 604).Only treatments according to the German S3 guidelines were included.Endpoints were overall survival (OS) and time to progression. Results:Staging accuracy was evaluated in all patients with initial surgery (n=3981).Clinical-pathological staging discordance here was substantial, with agreement only in 42.0%.Upstaging was more common (31.8%) than down-staging (26.2%).In group I, adjuvant platinum therapy (n=537) improved OS versus surgery alone (n=473; HR 0.52, 95%CI 0.4-0.7).Cisplatin (n=340) and carboplatin (n=197) showed comparable OS (HR 1.0).Median time to progression was 452 days for both platinum groups versus 329 days for surgery alone (p = 0.034).In group II, Durva maintenance conferred the highest benefit (RCT+Durva vs. RCT; HR 0.55, 95%CI 0.4-0.7).Here cisplatin was more effective in non-squamous tumors, while in squamous tumors both platinums performed comparable.Median time to progression was longest for cisplatin-RCT + Durva (339 days), followed by cisplatin-RCT (283), carboplatin-RCT + Durva (280) and carboplatin-RCT (218).Conclusions: Real-world evidence from BWCR interestingly reveals considerable staging discrepancy in non-metastatic NSCLC.Adjuvant platinum therapy confers benefit to pIII-patients irrespective of platinum regimen, while in cIII-disease, Durva maintenance and histology-specific platinum selection significantly influence outcomes.

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