Feasibility of neoadjuvant immunochemotherapy in potentially resectable non-small cell lung cancer: a single-arm...

Potentially resectable, stage IIB-IIIB non-small cell lung cancer (NSCLC) presents a significant therapeutic challenge. Factors such as tumor size, location, or nodal status often preclude initial complete resection, necessitating novel strategies to improve prognosis. While neoadjuvant immunochemotherapy has demonstrated promise in metastatic/advanced NSCLC, evidence for its application in the potentially resectable setting remains limited. This study synthesizes the existing evidence and evaluates the efficacy, pathological response rates, and frequency of treatment-related events associated with neoadjuvant immunochemotherapy in this specific patient population.

A single-arm meta-analysis was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-NMA guidelines. A systematic search of databases (PubMed, Embase, and Cochrane) was performed up to 9 December 2025, for studies investigating neoadjuvant anti-PD-1/PD-L1 therapy combined with chemotherapy in potentially resectable NSCLC. Data were analyzed using STATA 14. A random-effects model was employed for significant heterogeneity (I ² > 50%); otherwise, a fixed-effects model was used. Sensitivity analyses, Begg's test/Egger's test, and the trim-and-fill method were applied to assess bias.

A total of 34 studies involving 1,885 patients were included. The pooled surgical resection rate was 76.0% (95% CI: 70.0%-82.0%; I ² = 89.34%). The R0 resection rate was 100% (95% CI: 99%-100%; I ² = 0.00%). The pathological complete response (pCR) rate was 35.9% (95% CI: 30.7%-41.0%; I ² = 13.94%), and the major pathological response (mPR) rate was 25% (95% CI: 21%-29%). The combined rate of pCR and mPR was 60.2% (95% CI: 55.1%-65.4%; I ² = 65.70%). The incidence of grade ≥3 adverse events (AEs) was 9.0% (95% CI: 5.0%-14.0%; I ² = 82.05%), and the rate of surgical complications was 8.0% (95% CI: 3.0%-15.0%; I ² = 82.37%). Sensitivity analyses and the trim-and-fill method supported the robustness of the results, with no significant publication bias detected.

This single-arm meta-analysis suggests that for patients with potentially resectable NSCLC, neoadjuvant immunochemotherapy followed by surgery shows promising short-term pathological response rates and acceptable rates of treatment-related events, indicating potential feasibility. However, because of the lack of comparator data and mature long-term survival outcomes, its definitive clinical benefit remains uncertain. Our results provide preliminary evidence and rationale for initiating randomized controlled clinical trials in this population to compare the efficacy and safety of surgery after neoadjuvant immunochemotherapy versus current standard therapy.

https://www.crd.york.ac.uk/prospero/, identifier CRD42024579329.