Impacts of Multidisciplinary Tumor Boards and Surgery Integration on NSCLC Survival

In a retrospective cohort study involving 242 patients with stage III non-small cell lung cancer, researchers from Changhua Christian Hospital in Taiwan report that both multidisciplinary tumor board (MTB) discussions and surgical intervention independently and synergistically improved overall survival (OS).

Multidisciplinary Collaboration Yields Measurable Survival Gains

The inclusion of MTBs—structured, collaborative discussions involving thoracic surgeons, oncologists, radiologists, and other specialists—was associated with a marked improvement in survival across all stage III subgroups. Median OS in the MTB group reached 30.9 months, compared to 14.9 months in the non-MTB cohort (P = 0.001).

Notably, patients with stage IIIc disease benefited most. Five-year OS was 50 percent with MTB involvement—more than triple the 14.8 percent observed in standard care.

The design allowed for subgroup analysis by clinical stage, with consistent trends favoring MTB engagement. However, in multivariate analysis, MTB wasn’t found to be statistically significant as an independent predictor (HR = 0.74, P = 0.092).

Surgical Resection: Still Underutilized but Decisively Effective

Surgical treatment emerged as the strongest modifiable factor associated with survival improvement with an adjusted HR of 0.41 (95% CI: 0.27–0.63), translating to a 59% reduction in mortality risk. Across the entire cohort, patients who underwent surgery had a median OS of 36.4 months, in stark contrast to 11.2 months in non-surgical patients (P < 0.001).

Interestingly, even in the non-MTB cohort, surgical candidates had a median OS of 41.3 months, suggesting that when surgery is viable, its impact may transcend broader system-level coordination—but optimal outcomes are achieved when surgery is guided by MTB input.

A Changing Therapeutic Landscape

With the NSCLC treatment paradigm rapidly evolving—spurred by neoadjuvant chemo-immunotherapy, consolidation immunotherapy, and refined TNM staging—MTBs appear increasingly critical in navigating this complexity. As newer treatments blur conventional lines between operable and inoperable disease, MTBs offer a dynamic forum to reassess resectability and integrate emerging evidence into practice.

Practical takeaways for clinical teams include:

• Early MTB involvement should be prioritized, especially for borderline stage III NSCLC cases where resectability is uncertain or multimodality therapy is being considered.
• Surgical intervention should remain on the table even for select patients with stage IIIb or IIIc disease, especially when preceded by induction therapy and MTB evaluation.
• Comprehensive staging and timely treatment sequencing facilitated by MTBs can close the gap between evolving guidelines and real-world implementation.

As a single-center, retrospective study, these findings warrant cautious interpretation. Selection bias cannot be ruled out, particularly as MTB allocation was non-randomized. Additionally, the rapid evolution of NSCLC therapeutics—including biomarker-driven treatments—means ongoing reassessment of MTB and surgical roles is necessary. Prospective, multicenter trials are needed to validate the survival benefit in diverse care settings and define which patient subsets derive maximal value from MTB-guided resection strategies.

The integration of multidisciplinary tumor boards and surgical resection in Stage III NSCLC isn’t just complementary—it’s potentially life-extending. As oncologic complexity increases, coordinated, evidence-informed collaboration may offer one of the clearest paths to improving survival in this high-stakes patient population.

Reference

Tong SS, Chen YL, Cheng YF, et al. Multidisciplinary tumour boards and surgical intervention improve overall survival in patients with stage III non-small-cell lung cancer: a retrospective cohort study. Interdiscip Cardiovasc Thorac Surg. 2025;40(7):ivaf141. doi:10.1093/icvts/ivaf141