Decision-to-outcome analysis of multidisciplinary tumor board-managed NSCLC patients

Background: Neoadjuvant therapy is recommended for selected patients with non-small cell lung cancer; however, concerns about disease progression, loss of surgical opportunity, and treatment-related mortality limit its adoption. Multidisciplinary tumor board (MDT) aims to optimize treatment sequencing, yet comprehensive real-world data integrating treatment-related and oncologic outcomes remain limited. This study evaluated progression, resection rates, treatment-related mortality, and long-term oncologic outcomes within a multidisciplinary management framework. Methods: This retrospective cohort included 769 patients discussed by a thoracic oncology board between May 2015 and November 2019. Treatment strategies comprised upfront surgery, neoadjuvant therapy followed by planned surgery, definitive chemoradiotherapy, or non-surgical management. The primary outcome was progression during neoadjuvant therapy. Secondary outcomes included resection rates, treatment-related mortality, pathological response, and overall survival. Results: Neoadjuvant therapy was recommended in 275 patients (35.8%). Disease progression occurred in 8 patients (2.9%). Curative-intent resection was achieved in 246 patients (89.5%). Treatment-related mortality during neoadjuvant therapy was 1.1%, compared with 5.3% after definitive chemoradiotherapy and 0.4% overall surgical mortality. Pathological complete response was observed in 13.4%. Among stage III patients, five-year overall survival was 69.0% in the neoadjuvant surgery group versus 20.0% in the non-surgical group. Conclusion: In this MDT-managed non-small cell lung cancer cohort, low progression rates and high resection rates were observed among patients selected for neoadjuvant therapy. These findings describe real-world treatment completion and clinical outcomes within a multidisciplinary management framework.