Yuechen Cui, Xuguang Zhang, Miao Wang, Guanhua Liu, Chunquan Liu, Leina Sun, Zhanshuo Zhang, Shuo Wang, Jiping Xie, Zhenfa Zhang, Changli Wang, Bin Zhang, Mu Hu, Kang Zheng, Hongyan Wang, Hefei Li, Dongsheng Yue
In this multicenter real-world cohort, postoperative adjuvant therapy was not associated with improved DFS or OS among patients achieving pCR after neoadjuvant therapy. Given the limited number of events and wide CIs, these findings should be interpreted as exploratory and further validated in prospective studies.
BACKGROUND: In patients with resectable non-small cell lung cancer (NSCLC), the use of immune checkpoint inhibitors in both the neoadjuvant and perioperative settings has been associated with significant survival benefits. However, the comparative efficacy of neoadjuvant versus perioperative therapy remains unclear, particularly among patients who achieve pathological complete response (pCR). This study investigated the role of postoperative adjuvant therapy in patients with NSCLC achieving pCR after neoadjuvant therapy.
METHODS: In this retrospective multicenter study, patients with clinical stage II-IIIB NSCLC who achieved pCR following neoadjuvant therapy between 2019 and 2024 were identified. To balance baseline covariates between the two groups, inverse probability of treatment weighting was employed for patients who did and did not receive adjuvant therapy. Disease-free survival (DFS) and overall survival (OS) were subsequently compared between the two groups, with subgroup analyses conducted according to pathological type and clinical stage.
RESULTS: A total of 186 patients were included, with 135 receiving adjuvant therapy and 51 undergoing observation alone. After a median follow-up of 33 months and adjustment via inverse probability of treatment weighting, no significant differences in DFS or OS were observed between the adjuvant therapy group and the observation cohort. Specifically, the comparison of DFS yielded a log-rank P value of 0.818 [hazard ratio (HR) =1.17; 95% confidence interval (CI): 0.31-4.37], and the comparison of OS yielded a log-rank P value of 0.705 (HR =1.37; 95% CI: 0.26-7.14). Treatment-related adverse events occurred in 18 patients receiving adjuvant therapy, leading to discontinuation in 10 cases.
CONCLUSIONS: In this multicenter real-world cohort, postoperative adjuvant therapy was not associated with improved DFS or OS among patients achieving pCR after neoadjuvant therapy. Given the limited number of events and wide CIs, these findings should be interpreted as exploratory and further validated in prospective studies.