Clinical lung cancer · 2026
Adjuvant Therapy After Pathologic Complete Response to Neoadjuvant Immunochemotherapy in Non-Small Cell Lung Cancer: A Multicenter Retrospective Real-World Study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Liu Haoran, Gu Zhitao, Yu Keke, Zhao Ze-Rui, Yan Wanpu, Fang Yifan, Yu Xiangyang, Jiang Long, Wang Yiyang
Аннотация
BACKGROUND: Whether resectable stage II to IIIB non-small cell lung cancer (NSCLC) patients could benefit from adjuvant therapy when pathologic complete response (pCR) is achieved after neoadjuvant immunochemotherapy remains unclear.
METHODS: We conducted a multicenter retrospective real-world study including patients with resectable stage II to IIIB NSCLC who achieved pCR after neoadjuvant immunochemotherapy and curative-intent resection between January 2020 and December 2023. Patients were categorized according to receipt of adjuvant systemic therapy or surveillance alone. Disease-free survival (DFS) was the primary outcome. Overall survival (OS), cancer-specific survival, recurrence patterns, and treatment-related adverse events (TRAE) were secondary outcomes. Propensity score matching and multivariable Cox regression were used for survival analyses.
RESULTS: Among 214 eligible patients, 133 received adjuvant therapy and 81 underwent surveillance. During a median follow-up of 29.5 months, 25 patients experienced recurrence and 11 died. After propensity score matching, 148 patients (74 per group) were included. In the matched cohort, adjuvant therapy was not associated with improved DFS (pair-stratified hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.51-2.95) or OS (pair-stratified HR 1.00, 95% CI 0.20-4.96) compared with surveillance alone. Recurrence after pCR was predominantly distant. Grade 3 or higher TRAEs were observed in 18% of patients who received adjuvant therapy.
CONCLUSIONS: In patients achieving pCR after neoadjuvant immunochemotherapy, adjuvant systemic therapy was not associated with improved survival outcomes compared with surveillance alone and was accompanied by treatment-related toxicity. These findings suggest postoperative surveillance may be an appropriate consideration in discussions of postoperative management after confirmed pCR.
METHODS: We conducted a multicenter retrospective real-world study including patients with resectable stage II to IIIB NSCLC who achieved pCR after neoadjuvant immunochemotherapy and curative-intent resection between January 2020 and December 2023. Patients were categorized according to receipt of adjuvant systemic therapy or surveillance alone. Disease-free survival (DFS) was the primary outcome. Overall survival (OS), cancer-specific survival, recurrence patterns, and treatment-related adverse events (TRAE) were secondary outcomes. Propensity score matching and multivariable Cox regression were used for survival analyses.
RESULTS: Among 214 eligible patients, 133 received adjuvant therapy and 81 underwent surveillance. During a median follow-up of 29.5 months, 25 patients experienced recurrence and 11 died. After propensity score matching, 148 patients (74 per group) were included. In the matched cohort, adjuvant therapy was not associated with improved DFS (pair-stratified hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.51-2.95) or OS (pair-stratified HR 1.00, 95% CI 0.20-4.96) compared with surveillance alone. Recurrence after pCR was predominantly distant. Grade 3 or higher TRAEs were observed in 18% of patients who received adjuvant therapy.
CONCLUSIONS: In patients achieving pCR after neoadjuvant immunochemotherapy, adjuvant systemic therapy was not associated with improved survival outcomes compared with surveillance alone and was accompanied by treatment-related toxicity. These findings suggest postoperative surveillance may be an appropriate consideration in discussions of postoperative management after confirmed pCR.