Colony-stimulating factors improve neoadjuvant immunochemotherapy efficacy in non-small-cell lung cancer without EGFR or ALK mutations: A double-center real-world retrospective study.

BACKGROUND

Preclinical evidence suggests colony-stimulating factors (CSFs) may modulate antitumor immunity. This study evaluated granulocyte colony-stimulating factor (G-CSF) administration on neoadjuvant immunochemotherapy (NICT) efficacy in non-small-cell lung cancer (NSCLC) without EGFR or ALK mutations.

METHODS

In this double-center retrospective study (2019-2025), 439 stage II/III NSCLC patients without EGFR or ALK mutations receiving NICT followed by R0 resection were analyzed. Propensity score matching (PSM, 1:1) balanced baseline characteristics between G-CSF (n = 135) and control groups (n = 304), yielding 114 matched pairs. Primary endpoints included pathological complete response (PCR) and survival outcomes.

RESULTS

G-CSF administration during NICT significantly improved PCR rates (G-CSF vs. Control: unmatched 39.8% vs 26.7%, p = 0.011; PSM 43.9% vs. 28.1%, p = 0.019). The 2-year disease-free survival (DFS) was comparable between the two groups (unmatched: 81% vs. 79%; PSM: 79% vs 75%, p > 0.05). Multivariate analysis identified G-CSF as an independent factor for PCR in PSM cohort (OR = 2.09, 95%CI 1.19-3.72, p = 0.011), but not as an independent factor for DFS (p > 0.05). Tuberculosis, histological grade and adjuvant therapy were significant prognostic factors for DFS (p < 0.05).

CONCLUSIONS

For NSCLC patients without EGFR or ALK mutations receiving NICT, G-CSF administration could enhance PCR rates. Prospective trials evaluating G-CSF and GM-CSF combined with PD-1 inhibitors are warranted.