Chemoimmunotherapy improves surgical resection rate and survival versus chemotherapy in potentially resectable non-small cell lung cancer: a real-world propensity score-matched study.

BACKGROUND

Neoadjuvant chemoimmunotherapy (nCIT) has become the standard-of-care for resectable non-small cell lung cancer (NSCLC), due to its significant improvements in event-free survival (EFS) and overall survival (OS). However, the feasibility of conversion chemoimmunotherapy (CIT) in potentially resectable NSCLC remains unclear. In this context, this study will provide more reliable real-world data to support the robust efficacy of CIT in patients with potentially resectable NSCLC.

METHODS

This retrospective analysis enrolled patients with potentially resectable NSCLC who had no active oncogene mutation and underwent conversion therapy at four cancer centers between January 2021 and March 2024. All patients received either chemotherapy (CT) or CIT as conversion regimens. After 1:n propensity score matching (PSM), efficacy and safety were compared between groups using the following endpoints: surgical conversion rate, major pathological response (MPR) rate, pathological complete response (pCR) rate, EFS, and treatment-related adverse events (TRAEs).

RESULTS

A total of 334 patients were enrolled, with 252 in the CIT group and 82 in the CT group. After PSM, the final cohort comprised 196 patients in the CIT group and 78 in the CT group. CIT treatment showed significantly higher surgical conversion rate vs. CT (73.5% vs. 60.3%; P=0.03). After PSM analysis in the surgical cohort, 131 patients were matched to the CIT group and 49 to the CT group. Compared with CT, CIT obtained higher rates of MPR (60.3% vs. 20.4%; P<0.001) and pCR (39.7% vs. 12.2%; P<0.001), as well as significantly improved EFS [hazard ratio (HR) =0.28; 95% confidence interval (CI): 0.14-0.55; P<0.001]. Subgroup analysis revealed more obvious EFS benefit with CIT among patients with younger age (HR =0.172; 95% CI: 0.081-0.364; P=0.001), squamous cell carcinoma (SCC) (HR =0.197; 95% CI: 0.094-0.411; P=0.001), N2-3 (HR =0.279; 95% CI: 0.136-0.571; P=0.001), and stage III diseases (HR =0.347; 95% CI: 0.187-0.644; P=0.001). The incidence of TRAEs was comparable between the two groups, with nausea (27.5% vs. 22.4%), neutropenia (22.1% vs. 12.2%), and anorexia (17.6% vs. 14.3%) being the most common in both groups, with no other clinically significant immune-related adverse events (irAEs) observed. Furthermore, in the subset of 184 patients who achieved R0 resection following CIT, MPR was identified as an independent predictor of improved EFS (HR =0.305; 95%CI: 0.086-0.978; P=0.04).

CONCLUSIONS

In this retrospective cohort, CIT was associated with higher surgical conversion rates, MPR, pCR, and improved EFS vs. CT, with comparable safety. These findings support prospective evaluation of CIT in potentially resectable NSCLC.