The impact of neoadjuvant chemoimmunotherapy on pulmonary function in non-small cell lung cancer patients

Perioperative chemoimmunotherapy has suggested a survival benefit in patients with locally-advanced non-small cell lung cancer (NSCLC). This study aims to investigate whether neoadjuvant chemoimmunotherapy influences pulmonary function (PF).

A total of 253 patients with NSCLC who received neoadjuvant chemoimmunotherapy and tumor resection from May 2019 to January 2023 were included. The PF before and after neoadjuvant therapy was compared using a paired t-test, and the difference in the changes of PF between patients with and without chronic obstructive pulmonary disease (COPD) were compared by covariance analysis. Logistic regression analysis was performed to analyze factors influencing the change of PF.

The median age was 64 years. The rate of major pathologic response (MPR) was 53.4%, and 11.5% of patients had grade III-IV adverse events. After neoadjuvant chemoimmunotherapy, forced expiratory volume in one second (FEV1) (2.34 vs. 2.45 L, P<0.001) and the ratio of FEV1 to the predicted value (FEV1%pred) (86.10% vs. 89.50%, P<0.001) showed significant increase. In addition, 28.1% patients had COPD, and subgroup analysis revealed that FEV1 and FEV1%pred showed significant improvement after neoadjuvant treatment in patients with COPD, regardless of the presence of obstructive pneumonia/atelectasis. Covariance analysis revealed that FEV1 showed a more significant improvement after neoadjuvant treatment in patients with COPD compared to patients without COPD (0.189 vs. 0.075 L, P=0.049). Multivariate logistic analysis also found that COPD [odds ratio (OR), 2.273; 95% confidence interval (CI): 1.211-4.405] remained an independent factor for the improvement in FEV1.

An improvement in pulmonary ventilation function was observed in NSCLC patients after neoadjuvant chemoimmunotherapy. This improvement may potentially offer additional opportunities for surgical intervention in NSCLC patients with COPD.