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Neoadjuvant Chemoimmunotherapy Followed by Surgery or Radiotherapy for Stage IIIA-B Non-Small Cell Lung Cancer With
Suyu Wang1, Yifei Zhou1, Shiqi Hu2
1Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
The Annals of Thoracic Surgery
|March 7, 2026
Summary
Surgery after neoadjuvant chemoimmunotherapy significantly improves event-free survival (EFS) and overall survival (OS) for stage III non-small cell lung cancer (NSCLC) patients with bulky N2 disease compared to radiotherapy.
Area of Science:
- Oncology
- Thoracic Surgery
- Medical Oncology
Background:
- Optimal treatment for stage III non-small cell lung cancer (NSCLC) with bulky N2 disease is debated.
- Neoadjuvant chemoimmunotherapy is an emerging strategy for NSCLC.
Purpose of the Study:
- To evaluate the efficacy of neoadjuvant chemoimmunotherapy followed by surgery versus radiotherapy for stage III (N2) NSCLC with bulky N2 disease.
Main Methods:
- Retrospective review of 65 patients with stage III (N2) NSCLC treated with neoadjuvant chemoimmunotherapy.
- Comparison of event-free survival (EFS) and overall survival (OS) using Kaplan-Meier curves and Cox regression.
- Analysis of R0 resection, major, and complete pathological response rates.
Main Results:
- Surgery group (n=43) demonstrated significantly longer EFS and OS compared to the radiotherapy group (n=22).
- 3-year EFS and OS for the cohort were 53.7% and 81.2%, respectively.
- 100% R0 resection rate achieved in the surgery group, with 55.8% major and 27.9% complete pathological response.
Conclusions:
- Surgery is a feasible and effective consolidative treatment for selected stage III NSCLC patients with bulky N2 disease.
- Favorable response to neoadjuvant chemoimmunotherapy predicts better outcomes with surgery.
