WCLC 2025 - Posters & ePosters-P2.08 .11 Management of High-Grade Endobronchial Pre-Invasive Lesion: To Treat or Not to Treat?

Pdf Summary

This retrospective cohort study compared outcomes in patients with high-grade endobronchial pre-invasive lesions managed by two different strategies: primary endobronchial treatment versus treatment reserved until progression to squamous cell carcinoma (SCC). Conducted between 1998 and 2007 at University College London Hospitals (UK) and Amsterdam University Medical Center (The Netherlands), the study included 85 patients—34 (40%) received primary treatment at AUMC, while 51 (60%) at UCLH were treated only after progression to SCC.<br /><br />High-grade pre-invasive lesions have variable natural histories and potential to progress to SCC, but optimal management lacks consensus, leading to diverse treatment approaches across centers. Patients underwent surveillance with repeat bronchoscopy and CT scans.<br /><br />Results revealed that primary treatment significantly reduced the risk of progression to SCC (hazard ratio [HR] 0.39; p=0.002) and extended median progression-free survival (71.0 months vs. 38.0 months; p=0.002). Overall survival was also improved in the primary treatment group (HR 0.47; p=0.015), independent of age. Notably, the group treated on progression was younger (median age 67 vs. 77 years) and had a higher proportion of carcinoma in situ cases (78.4% vs. 38.2%), indicating more advanced disease at diagnosis.<br /><br />In conclusion, the study supports that proactive endobronchial treatment of high-grade pre-invasive lesions improves progression-free and overall survival. However, the greater incidence of carcinoma in situ in the delayed-treatment group suggests disease severity may influence outcomes. These findings highlight the need for careful evaluation when deciding treatment timing for pre-invasive endobronchial lesions, considering potential benefits of early intervention versus observation. Further prospective studies are warranted to establish standardized management guidelines.

Asset Subtitle

Illaa Smesseim

Meta Tag

Speaker Illaa Smesseim

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

retrospective cohort study

high-grade endobronchial pre-invasive lesions

primary endobronchial treatment

squamous cell carcinoma progression

University College London Hospitals

Amsterdam University Medical Center

progression-free survival

overall survival

carcinoma in situ

treatment timing in endobronchial lesions