Abstract
OBJECTIVES: To evaluate the prognosis of patients with nonsmall cell lung cancer (NSCLC) who did not undergo surgery after neoadjuvant chemotherapy combined with immunotherapy (NACI). Patients were grouped according to subsequent treatment: radiotherapy (RT) or nonradiotherapy (non-RT), and the prognostic importance of positron emission tomography/computed tomography (PET/CT) was further assessed. MATERIALS AND METHODS: This retrospective study included NSCLC patients who received NACI between November 2020 and September 2024 at the Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College. Not all patients underwent surgery and subsequently received either RT or non-RT treatment. Patients were stratified by whether PET/CT was performed and by their SUV-max values before RT or non-RT. Progression-free survival (PFS) and overall survival (OS) were calculated from the start of neoadjuvant therapy using the Kaplan-Meier method. RESULTS: A total of 73 eligible patients were enrolled: 21 (28.8%) in the non-RT group (nRTG) and 52 (71.2%) in the RT group (RTG). The median follow-up time for all patients in the group was 18 months. The results show no significant difference in PFS (p = 0.653) or OS (p = 0.742) between RTG and nRTG. Among the patients who did not undergo PET/CT examination, the results showed a significant difference in PFS (p = 0.022), but no difference in OS (p = 0.320). Among the patients undergoing PET/CT examinations, in terms of PFS, compared to nRTG + SUV-max ≤ 4 g/mL, there is no significant difference in RTG + SUV-max ≤ 4 g/mL (p = 0.584), and RTG + SUV-max > 4, < 8 g/mL (p = 0.156). However, RTG + SUV-max ≥ 8 shows a statistical difference (p = 0.005). CONCLUSION: Among NSCLC patients who did not undergo surgery following NACI, no significant differences in OS or PFS were observed between the RTG and nRTG groups. For patients who did not receive PET/CT evaluation, radiotherapy remains a key therapeutic option. In patients with a PET/CT SUVmax ≤ 4, radiotherapy may be safely omitted. In comparison, patients with a PET/CT SUVmax > 4 should be managed with a comprehensive treatment strategy that includes radiotherapy as the main component. PET/CT plays a critical role in guiding subsequent treatment selection.