Prognostic impact of residual viable tumor percentage on non-small cell lung cancer recurrence after neoadjuvant immunochemotherapy.

BACKGROUND

Recent clinical trials have identified the percentage of residual viable tumor (%RVT) following neoadjuvant immunochemotherapy as a prognostic risk factor for patients with non-small cell lung cancer (NSCLC). This study aimed to identify the significance of %RVT concerning the patterns of postoperative recurrence.

METHODS

This retrospective study involved 339 patients diagnosed with NSCLC who underwent neoadjuvant immunochemotherapy followed by radical surgical intervention. The optimal cutoff value of %RVT was identified as a continuous covariate for recurrence-free survival (RFS) using the rolr R package.

RESULTS

In our cohort, the estimated optimal cutoffs for %RVT were identified as 5% and 30%. Patients with >30% RVT exhibited significantly worse RFS compared to those with 6-30% RVT (P = 0.026) and those with ≤5% RVT (P < 0.001). The overall recurrence rate (≤5% RVT, 12.2%; 6-30% RVT, 29.4%; >30% RVT, 37.1%; P < 0.001) and distant recurrence rate (≤5% RVT, 2.7%; 6-30% RVT, 16.7%; >30% RVT, 24.7%; P < 0.001) increased progressively with advancing %RVT. Cox regression analyses revealed that %RVT, visceral pleural infiltration, lymphovascular infiltration, and pN stage were independent risk factors for RFS. Based on these identified factors, a nomogram model was subsequently developed, yielding a corrected C-index of 0.701 through bootstrap analysis.

CONCLUSIONS

We identified %RVT in post-treatment tumor lesions as a significant risk factor for the recurrence of NSCLC following neoadjuvant immunochemotherapy and surgery, with optimal cutoffs established at 5% and 30%. Furthermore, an increase in %RVT may have a more pronounced effect on distant recurrence.