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Background Neoadjuvant chemoimmunotherapy and adjuvant immunotherapy is a standard of care for resectable non-small cell lung cancer. However, high non-adherence rates challenge its implementation and benefits. We assessed the risks and long-term outcomes of completing this full regimen versus non-completion in a real-world setting. Methods Patients with resectable non-small cell lung cancer at clinical stage IB-IIIB who received neoadjuvant chemoimmunotherapy followed by surgery were included. Patients were divided into a completed group (n=37), who received four cycles of perioperative chemoimmunotherapy and one year of adjuvant immunotherapy, and a non-completed group (n=127). Inverse Probability of Treatment Weighting was used to adjust baseline characteristics. Kaplan-Meier curves compared recurrence-free survival, overall survival, and cumulative hazard of adverse events. Cox regression models assessed predictors for recurrence and subgroup analyses were performed. Results No significant differences were in recurrence-free survival (P = 0.85) or overall survival (P = 0.34) between the two groups. Positive pathological nodal status was an independent predictor of recurrence, while completion status was not (adjusted hazard ratio 1.14, 95% CI 0.24-5.50, P = 0.87). The completed group experienced a higher incidence of any-grade adverse events (AEs), but no significant increase in Grade 3/4 AEs. Subgroup analysis revealed a notable recurrence benefit from completion in patients who were aged 65 years and ECOG score 0. Conclusion Completing perioperative chemoimmunotherapy protocol did not significantly increase the risk of severe AEs, but also failed to demonstrate a survival benefit. Prospective studies and extended follow-up duration were needed to verify the conclusions.
Tian et al. (Thu,) studied this question.