Abstract
BACKGROUND: In patients with resectable non-small cell lung cancer (NSCLC), recent clinical trials have highlighted the survival advantages conferred by chemoimmunotherapy in both the neoadjuvant and perioperative treatment settings. Despite these findings, a direct comparative analysis to discern the superior protocol between neoadjuvant and perioperative approaches remains an uncharted territory. Therefore, this study aimed to compare the efficacy of neoadjuvant chemoimmunotherapy (NT) and perioperative (chemo)immunotherapy (PT) in resectable NSCLC. METHODS: We performed a single-center retrospective study at Zhejiang Cancer Hospital, identifying 318 patients who underwent surgical intervention for stages IB-IIIB NSCLC between 2019 and 2021, with participants stratified into two groups based on distinct treatment strategies: NT or PT. We employed propensity score matching (PSM) to adjust for confounding variables, and subsequently utilized Kaplan-Meier survival curves and Cox proportional hazards regression models to investigate the correlation between treatment regimens and survival at the postoperative mark. RESULTS: Following PSM, 248 patients were included (NT, 124; PT, 124). Comparative analyses underscored the efficacy disparities between NT and PT. In the overall population analysis, the PT group demonstrated superior event-free survival (EFS) [hazard ratio (HR), 0.48; 95% confidence interval (CI), 0.29-0.78; P=0.003] and improved overall survival (OS) (HR, 0.43; 95% CI, 0.23-0.79; P=0.006) compared with the NT group. Notably, subgroup analyses revealed in patients without a pathological complete response (pCR), the PT group experienced significantly enhanced EFS with a 3-year EFS rate of 76.5% compared to 57.5% in the NT group (HR, 0.48; 95% CI, 0.28-0.83; P=0.008), as well as improved OS with a rate of 84.4% versus 71.7% (HR, 0.48; 95% CI, 0.24-0.94; P=0.03). However, no statistically significant differences in EFS and OS were observed between the two treatment groups among patients who achieved pCR. Additionally, PT significantly improved EFS and OS in stage IIIA-IIIB patient populations. Multivariate analyses further revealed pCR as an independent prognostic factor for longer EFS in stage IB-IIIB NSCLC patients (HR, 0.42; 95% CI, 0.22-0.80; P=0.009). CONCLUSIONS: Our study demonstrated that in comparison with NT, the PT approach can significantly enhance the survival prognosis for patients with resectable stage IB-IIIB NSCLC. Notably, patients without a pCR after surgery may stand to benefit more from the perioperative treatment approach.