Induction chemoimmunotherapy and surgery for unresectable stage III non-small cell lung cancer

Concurrent chemoradiation plus consolidation immunotherapy is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC), however, whether induction chemoimmunotherapy plus surgery can provide good efficiency and safety for this population is unclear. This study aims to evaluate the efficacy and safety of induction chemoimmunotherapy plus surgery in unresectable stage III NSCLC.

Patients with stage I-III NSCLC receiving neoadjuvant/induction chemoimmunotherapy were screened. Kaplan-Meier method, propensity score matching (PSM), Cox regression, and subgroup and sensitivity analysis were used for comparation in disease-free survival (DFS) and overall survival (OS). Perioperative safety was also analyzed.

A total of 425 NSCLC patients underwent neoadjuvant/induction chemoimmunotherapy plus surgery consisting of 278 with unresectable stage III and 147 with resectable IB-IIIA disease were enrolled. DFS was comparable between unresectable and resectable cohort before [hazard ratio (HR): 0.95, 95% confidence interval (CI): 0.65-1.38, P=0.77] and after (HR: 1.08, 95% CI: 0.66-1.76, P=0.75) PSM. In addition, OS before (HR: 1.07, 95% CI: 0.57-2.02, P=0.83) and after (HR: 1.40, 95% CI: 0.63-3.09, P=0.41) PSM had no significant difference between the two cohorts. The 3-year DFS (68.7% vs. 66.2%) and OS (87.8% vs. 89.3%) were similar in the two cohorts respectively. Subgroup and sensitivity analysis exhibited consistent results. R0 resection rate, blood loss in surgery, length of hospital stay after surgery, 30-day mortality, and 90-mortality also showed no significant difference between the two cohorts.

Induction chemoimmunotherapy plus surgery can bring satisfying DFS/OS with good safety for unresectable stage III NSCLC.