Executive Summary
Best of Lung Cancer Science at 2025 World Conference on Lung Cancer
The STS 2025 Best of Lung Cancer Science special edition podcast series offers members direct access to the most relevant and practice-changing science in lung cancer, curated and interpreted by thoracic surgeons for thoracic surgeons.
This executive summary breaks down the key takeaways on pivotal research and emerging themes from top studies presented at the 2025 World Conference on Lung Cancer.
Gain unique insights on how lung cancer surgery and perioperative care are being transformed by precision data, thoughtful surgical restraint, and breakthrough immunotherapy results from Erin Gillaspie, MD, Chief of Thoracic Surgery, CHI Health, and podcast host, and her guest, Leah Backhus, MD, Thelma and Henry Doelger Professor, Division of Thoracic Surgery, Stanford University.
1. Redefining Surgical Extent in Early-Stage Adenocarcinoma
This landmark randomized trial evaluated the role of lymph node dissection in patients with extremely early-stage adenocarcinoma, including those with ground-glass–dominant nodules and a consolidation-to-tumor ratio below 0.5. The study compared systematic mediastinal lymph node dissection versus no dissection and found:
• No nodal metastases in any patients meeting the inclusion criteria.
• Comparable oncologic outcomes between the two groups.
• Significant reductions in operative time (74 vs. 109 minutes), estimated blood loss, and hospital length of stay for the limited-surgery group.
• The study was terminated early after interim safety analyses confirmed no nodal disease and raised concerns for unnecessary risk.
These results suggest that for select patients with small, indolent, ground-glass–dominant adenocarcinomas, routine mediastinal lymph node dissection may be unnecessary, a meaningful step toward more tailored, less invasive surgery.
Dr. Backhus noted that while this study “validated her current practice” of omitting lymph node dissection for such cases, it also poses challenges for surgical quality metrics, such as the Commission on Cancer (COC) audit requirements that credit lymph node sampling based on pathology reports rather than operative findings.
Drs. Gillaspie and Backhus emphasized the need for professional societies and accrediting bodies to align quality benchmarks with emerging evidence that supports selective surgical approaches.
2. Implications for Clinical Practice
These findings fit within the evolving context of sublobar resections (JCOG, CALGB) and segmentectomy trends. Segmentectomies inherently yield N1 nodes, aligning well with the study’s approach. This reinforces a paradigm of precision surgery, removing only what is necessary to achieve cure, minimizing harm, and preserving function without compromising oncologic integrity.
3. Advancing Perioperative Immunotherapy: Keynote 671
The Keynote 671 trial is one of the first major perioperative studies to show a significant overall survival (OS) benefit with immunotherapy in resectable non–small cell lung cancer (NSCLC).
• This global, two-arm phase III trial compared neoadjuvant chemotherapy plus pembrolizumab (four cycles) versus chemotherapy alone, followed by surgery and adjuvant pembrolizumab or placebo.
• Findings at the four-year update showed improvements in event-free survival (EFS), major pathologic response (MPR), and pathologic complete response (pCR) across both node-negative and node-positive patient groups.
• OS data are still maturing but demonstrate sustained, durable trends in favor of the pembrolizumab arm.
This was the first perioperative lung cancer trial to demonstrate an overall survival benefit, marking a major turning point for multimodality treatment of resectable NSCLC.
Dr. Gillaspie underscored the importance of these results: “We’re now talking about 4- and 5-year survivals not even crossing that 50% mark with these regimens—numbers never before discussed in this disease space.”
4. Expanding Surgical Candidacy and Changing Treatment Paradigms
Dr. Backhus highlighted a broader shift in treatment: historically, patients with N2 or stage IIIB disease were considered poor surgical candidates. However, perioperative immunotherapy is redefining boundaries. With trials such as CheckMate 816, Aegean, NADIM, and now Keynote 671, thoracic surgeons are reconsidering the role of surgery in more advanced disease, particularly when combined with effective systemic therapy.
Drs. Backhus and Gillaspie agreed that this new evidence supports:
• Aggressive but safe local control following systemic therapy.
• Re-evaluation of current staging-based surgical exclusions.
• Integration of clinical, rather than purely pathologic, decision-making for patient selection and trial interpretation.
5. Looking Ahead: Collaboration and Adaptation
Dr. Gillaspie and Dr. Backhus delivered a call to action: as data rapidly evolve, thoracic surgeons and oncologists must work collaboratively to translate clinical trial evidence into real-world practice. Societies and accrediting bodies must also update surgical quality measures to reflect the nuance of patient selection, evidence-based restraint, and integration of immunotherapy.
Dr. Backhus summed it up: “Projects like this bring the data home. The next step is figuring out how to incorporate it into guidelines and quality frameworks that make sense for today’s thoracic practice.”
Main Points:
• Surgical restraint can be safe and evidence-based in early, ground-glass–dominant adenocarcinoma with no observed nodal metastases.
• Perioperative pembrolizumab demonstrates durable survival benefits, including in node-positive disease, confirming the value of combined-modality care.
• Precision, pragmatism, and safety are the new cornerstones of thoracic oncology decision-making.
• Ongoing collaboration among surgeons, oncologists, and professional societies is critical to ensure that clinical innovation drives guideline evolution and quality measures reflect real-world, patient-centered care.
Bottomline:
The studies presented at the 2025 World Conference on Lung Cancer underscore a pivotal moment in thoracic surgery, where precision, restraint, and multidisciplinary collaboration are redefining standards of care.
From limiting lymph node dissection in indolent, ground-glass–dominant tumors to expanding surgical opportunities through perioperative immunotherapy, the evidence points toward a future in which data-driven decision-making, thoughtful patient selection, and integration of systemic therapy guide every aspect of surgical practice.
For thoracic surgeons, staying at the forefront of these changes will mean not only mastering new science but also helping shape the evolving definition of quality and success in lung cancer care.