To the Editor In patients with early-stage non–small cell lung cancer (NSCLC), only whole tumor size has been well studied for its association with survival after adjuvant chemotherapy. In their recent Original Investigation using the National Cancer Database, Pathak et al1 assessed survival after adjuvant chemotherapy in patients with node-negative early-stage NSCLC stratified not only by tumor size but also by high-risk pathologic features (visceral pleural invasion, lymphovascular invasion, and poor differentiation) and resection type. In tumors of 3 to 4 cm, adjuvant chemotherapy showed survival benefits only in patients who underwent sublobar surgery, whereas in tumors of 4 to 5 cm, adjuvant chemotherapy was associated with survival benefits only in patients with at least 1 high-risk pathologic feature. The authors concluded that “high-risk pathologic features, extent of resection, and tumor size should be simultaneously considered when evaluating patients with early-stage NSCLC for adjuvant chemotherapy.”1
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Inamura K. Adjuvant Chemotherapy in Patients With Early-Stage Non–Small Cell Lung Cancer. JAMA Oncol. 2021;7(4):637–638. doi:10.1001/jamaoncol.2020.8189
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