Clinical outcomes for neoadjuvant immunochemotherapy or chemotherapy versus concurrent chemoradiotherapy in limited-stage small-cell lung cancer: A retrospective, multi-center, real-world study

The clinical value of neoadjuvant immunochemotherapy in limited-stage small-cell lung cancer (LS-SCLC) remains poorly defined, with limited comparative data available against concurrent chemoradiotherapy (CCRT). This retrospective multicenter study evaluated the efficacy and safety of neoadjuvant immunochemotherapy, chemotherapy, and CCRT in treatment-naive patients with potentially resectable SCLC. A total of 139 patients treated between February 2019 and December 2023 were included: 55 received CCRT, and 84 underwent neoadjuvant therapy followed by surgery (28 immunochemotherapy, 56 chemotherapy). Complete (R0) resection was achieved in all surgical cases. The pathological complete response (pCR) rate was significantly higher in the immunochemotherapy group than in the chemotherapy group (35.7% vs. 7.1%, p < .05), as was the major pathological response (MPR) rate (53.6% vs. 12.5%, p < .05). Adverse events were acceptable in the three groups. After propensity score matching (PSM), 24 patients from each group were included for survival analysis. Although median progression-free survival (PFS) and overall survival (OS) were not reached in the immunochemotherapy group, Kaplan-Meier analysis showed significantly prolonged PFS and OS compared with both chemotherapy and CCRT. These results suggest that neoadjuvant immunochemotherapy is a safe and effective treatment strategy for LS-SCLC and merits further investigation in prospective trials.