Is Neoadjuvant Chemoimmunotherapy Safe in Surgically High-Risk Lung Cancer Patients? A Single-Centre IPTW Analysis

Area of Science:

• Oncology
• Thoracic Surgery
• Medical Research

Background:

• Neoadjuvant chemoimmunotherapy is standard for resectable stage II-III non-small cell lung cancer (NSCLC), improving outcomes.
• Safety and efficacy data in high-risk surgical patients, who are underrepresented in clinical trials, remain unclear.

Purpose of the Study:

• To compare 30-day and 90-day mortality and oncological outcomes of neoadjuvant chemoimmunotherapy followed by surgery versus upfront surgery in high-risk NSCLC patients.
• To evaluate the safety and feasibility of neoadjuvant chemoimmunotherapy in a high-risk cohort.

Main Methods:

• Retrospective single-centre study of high-risk patients with resectable stage II-III NSCLC (January 2022 - December 2025).
• Patients were stratified into neoadjuvant chemoimmunotherapy (Chemo-IO) or upfront surgery groups.
• Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences.

Main Results:

• Neoadjuvant therapy was given to patients with higher comorbidity burden and more advanced disease.
• No significant difference in 30-day (0% vs 1.8%) or 90-day mortality (3.0% vs 3.5%) between groups after IPTW.
• R0 resection rates were numerically higher in the Chemo-IO group (87.9% vs 78.9%), with identical median hospital stays (6 days).

Conclusions:

• Neoadjuvant chemoimmunotherapy is safe and feasible in carefully selected, high-risk patients with resectable stage II-III NSCLC.
• Short-term perioperative outcomes were not compromised, with a trend towards improved R0 resection rates.
• Multimodal treatment strategies should be considered for high-risk NSCLC patients within multidisciplinary team (MDT) pathways.