Abstract
BACKGROUND: In recent years, neoadjuvant immunotherapy combined with chemotherapy has shown enhanced therapeutic efficacy and favorable surgical safety profile in the treatment of resectable non-small cell lung cancer (NSCLC). Currently, there has been no academic research that directly compares the efficacy of two different immune checkpoint inhibitors (ICIs). This study aims to evaluate the differences of the short-term efficacy and surgery-related safety of two different ICIs (sintilimab and camrelizumab), in conjunction with chemotherapy and followed by radical surgical resection in patients diagnosed with resectable NSCLC. METHODS: This is a single-center retrospective cohort study involving patients. All patients diagnosed with NSCLC at Tangdu Hospital between June 2018 and March 2024, who received neoadjuvant therapy involving programmed cell death protein-1 (PD-1) inhibitors (specifically sintilimab or camrelizumab) in combination with chemotherapy and followed underwent surgical interventions, were consecutively enrolled in the study. Subsequently, in order to control confounding variables as much as possible, we innovatively employed two novel matching methods based on baseline characteristics: the 1:1 propensity score matching (PSM) method and the inverse treatment probability weighting (IPTW). We compare the efficacy and surgical safety of two different ICIs for patients with resectable NSCLC. RESULTS: In total, 239 patients were enrolled, including 134 patients in the sintilimab group (SG) and 105 in the camrelizumab group (CG). Before PSM, the pathological complete response (pCR) rate did not differ between the SG and CG groups (42.5% vs. 35.2%, P=0.25). Similarly, the major pathologic response (MPR) rate (55.9% vs. 60.0%, P=0.53) and the objective response rate (ORR) (73.1% vs. 66.7%, P=0.28) rate were not different between the groups. Binary logistic analysis revealed that squamous cell carcinoma was a promoter of pCR [P=0.01, 95% confidence interval (CI): 15.2-77.6]. In total, 91 pairs of patients were matched by PSM. No differences were observed in the pCR rate (45.1% vs. 39.6%, P=0.45), the MPR rate (58.2% vs. 64.8%, P=0.36) and the ORR rate (75.8% vs. 67.0%, P=0.19) between the SG and CG groups. CONCLUSIONS: In the neoadjuvant chemoimmunotherapy treatment of resectable NSCLC, sintilimab and camrelizumab demonstrated comparable short-term efficacy and surgical safety when administered in conjunction with chemotherapy.