Effect of Interval Between Neoadjuvant Immunochemotherapy and Radical Resection of Non-Small Cell Lung Cancer: A...

Radical surgery following neoadjuvant immunochemotherapy (NICT) has emerged as a critical therapeutic strategy in the standardized management of locally advanced non-small cell lung cancer (NSCLC). Robust evidence on the optimal time interval between NICT and surgery is lacking. Patients were divided into three groups based on the interval between the completion of NICT and surgery: short interval group (SIG; < 4 weeks), intermediate interval group (IIG; 4-6 weeks), and long interval group (LIG; > 6 weeks). Inverse probability treatment weighting (IPTW) and weighted regression analysis were used to balance the baseline characteristics and compare the outcomes. 205 out of 335 screened patients met the inclusion criteria and were enrolled. When compared with the IIG, the SIG (OR, 0.15; 95% CI, 0.06-0.38; p < 0.001) was significantly correlated with lower pCR rate and the DFS was worse in the LIG (HR, 2.35; 95% CI, 1.15-4.80; p = 0.019). Subgroup analysis revealed that, in patients with a poor tumor regression response, LIG was significantly associated with poorer DFS (HR, 5.15; 95% CI, 2.27-11.71; p < 0.001) and OS (HR, 4.52; 95% CI, 1.48-13.79; p = 0.008) when compared with the IIG. Similarly, in patients with non-pCR, LIG was significantly associated with poorer DFS (HR, 3.25; 95% CI, 1.39-7.61; p = 0.006) and OS (HR, 2.72; 95% CI, 1.00-7.38; p = 0.049). Surgery performed within 4-6 weeks after the completion of NICT is associated with improved pCR and DFS. Emphasis should be placed on early surgical treatment after NICT, particularly in patients who have poor or no response to NICT.