Real-World Experience With Multimodal Treatment of Resectable Stage II-III Non-Small Cell Lung Cancer: A Single Institutional Analysis

Neoadjuvant therapy has recently become an integral component of multimodal treatment for resectable lung cancer. However, real-world data on perioperative morbidity and treatment adherence remain limited. This study aimed to assess the feasibility and safety of different neoadjuvant treatment approaches applied within daily clinical routine. We retrospectively analyzed patients with resectable stage II-III non-small cell lung cancer undergoing either neoadjuvant chemoimmunotherapy or chemotherapy/chemoradiotherapy followed by curative surgical resection. Treatment groups were compared with respect to perioperative outcomes, radiologic and pathologic downstaging, and pathologic response. A total of 143 patients met the inclusion criteria, of whom 46 (32.2%) received chemoimmunotherapy and 97 (67.8%) were treated with chemotherapy prior to surgery. Adverse events leading to treatment discontinuation occurred in only two patients in the chemoimmunotherapy group and four patients in the chemotherapy group. Chemoimmunotherapy was associated with significantly higher rates of pathologic complete response (37.0% vs. 4.1%) and more pronounced nodal downstaging, with a higher proportion of patients achieving ypN0 status (76.1% vs. 34.0%). High tumoral PD-L1 expression (≥ 50%) and squamous cell carcinoma histology were independently associated with pathologic complete response. Real-world treatment with neoadjuvant chemoimmunotherapy was feasible and resulted in improved response rates compared with chemotherapy, without increasing perioperative morbidity. Histology and high PD-L1 expression may serve as predictors for complete pathologic response, although the predictive value of PD-L1 requires confirmation in larger cohorts with more complete biomarker data.