Survival benefit of neoadjuvant therapies in patients with surgically resected non-small cell lung cancer with pathologic complete response.

BACKGROUND: Although the prognostic value of pathologic complete response (pCR) status has varied based on neoadjuvant strategy for operable, advanced non-small cell lung cancer (NSCLC), its value after neoadjuvant chemoimmunotherapy as compared to the other strategies is unknown. We aim to investigate the long-term survival benefits in patients receiving neoadjuvant chemotherapy alone, chemoradiation, or chemoimmunotherapy for surgically resected NSCLC with pCR. METHODS: A retrospective cohort review was completed utilizing the National Cancer Database from 2017-2020. Patients with cT1B-3A NSCLC who received neoadjuvant therapy prior to surgical resection, and pCR were included. Basic demographic information, short-term outcomes, and available surgical data were collected. Long-term outcomes were assessed via Kaplan-Meier analysis with log-rank tests and multivariable regression analysis. RESULTS: We identified 584 patients between 2017 and 2020. A majority presented with clinical stage III NSCLC (64.4%, n=376) and underwent lobectomy (86.9%, n=505). A majority received chemoradiation (59.8%, n=349), followed by chemotherapy alone (25%, n=146) and chemoimmunotherapy (15.2%, n=89). There was a significant association with improved 5-year overall survival (OS) in patients who achieved PCR status between chemoimmunotherapy (84.4%) and chemoradiation (70%) (P<0.05). There was no significant difference in OS between neoadjuvant chemoimmunotherapy (84.4%) vs. chemotherapy alone (82%) (P=0.65). CONCLUSIONS: In patients with NSCLC with pCR, there was a significantly greater association of OS in patients who received neoadjuvant chemoimmunotherapy compared to those who received chemoradiation. There was no significant survival difference between chemoimmunotherapy and chemotherapy alone.