Clinical outcomes with definitive surgery or radiotherapy after neoadjuvant immunochemotherapy in stage II-III NSCLC: Full cohort pragmatic analysis.

• DOI: 10.1200/jco.2025.43.16_suppl.8059
• Publication Date: 2025-05-28T13:33:39Z
• Authors: Jie He; Zhenlin Yang; Shuaibo Wang; Xiangyang Yu; Xiaotong Guo; JianJiao Ni; Linhai Zhu; Jian Hu; Guoqing Zhang; Chun Chen; Chun Chen; Guangjian Zhang; Bin Hu; Cui Gao; Lipin Liu; Pan Chen; Huajie Xing; Chuanbao Xia
• Keywords: Neoadjuvant Therapy

8059 Background: Recently, several landmark randomized controlled trials on neoadjuvant immunochemotherapy (NIC) have significantly changed the treatment paradigm for locally advanced NSCLC. However, 8.8-19.0% of patients (pts) receiving NIC did not undergo surgery due to various reasons. The strategies and clinical outcomes following stage II-III NSCLC, encompassing both surgical non-surgical approaches, remain unclear. Methods: We conducted a multicenter, retrospective cohort study involving (T1-4N0-2) pts who underwent radical or radiotherapy after in routine practice across 12 medical centers China between January 2018 December 2023. For radiotherapy, we documented reasons management, planned procedures. Propensity score matching (PSM) was performed based age, gender, smoking history, stage, histology balance clinicopathologic characteristics. primary were progression free survival (PFS) overall (OS). Results: 967 included: 683 (70.6%) 284 (29.4%) received radiotherapy. Reasons included potentially resectable but declined shared decision-making (65.5%, 186/284), functionally unresectable (14.4%, 41/284), technically (20.1%, 57/284), respectively. At database lock (November 24, 2024; median follow-up: 23.3 months), PFS (HR: 0.32, 95% CI: 0.23-0.44, p<0.001) OS 0.41, 0.26-0.66, improved undergoing PSM. most key subgroups favored surgery: IIIA 0.34, 0.21-0.55, p <0.001), IIIB 0.39, 0.24-0.63, (planned) pneumonectomy 0.47, 0.26-0.85, p=0.013) lobectomy 0.24, 0.13-0.45, p<0.001). group exhibited similar compared those pneumonectomy. Conclusions: Among with NSCLC treated NIC, demonstrated long-term benefit. Subgroups N (S) (R) HR (95% CI) p-value All 365 183 0.32 (0.23, 0.44) <0.001 Disease II 34 17 0.05 (0.01, 0.24) 175 89 0.34 (0.21, 0.55) 142 76 0.39 (0.24, 0.63) (Planned) Surgery Pneumonectomy 66 0.47 (0.26, 0.85) 0.013 Left 46 0.52 1.04) 0.066 Lobectomy 106 54 0.24 (0.13, 0.45) 0.41 0.66) 0.08 0.004 0.60 (0.28, 1.25) 0.17 0.45 0.87) 0.018 Sugery 0.87 (0.37, 2.06) 0.76 0.59 1.49) 0.26 0.33 (0.14, 0.76) 0.009