Outcomes After Neoadjuvant Therapy With or Without Immunotherapy Followed By Pneumonectomy in Non-Small Cell Lung Cancer Patients.

Background: There are limited data concerning pneumonectomy after preoperative induction therapy. Our study aimed to evaluate feasibility and safety of pneumonectomy after neoadjuvant immunotherapy in patients with non-small cell lung cancer by assessing postoperative outcomes.

Methods: A total of 1187 patients who underwent pneumonectomy for non-small cell lung cancer were retrospectively analyzed from 3 hospitals in China. Propensity score matching was adopted to form a balanced cohort between neoadjuvant therapy and non-neoadjuvant therapy groups. Univariable and multivariable logistic regression analyses were used to identify risk factors for postoperative morbidity. Efficacy and survival were compared for neoadjuvant therapy with or without immunotherapy.

Results: The neoadjuvant group had larger tumors (4.7 ± 2.2 cm vs 3.9 ± 1.9 cm [P < .001]; cT4, 36.3% vs 19.1% [P < .001]), had a greater rate of N2 metastases (64.5% vs 33.3%; P < .001), and were at a more advanced clinical TNM stage (stage III, 89.4% vs 58.6%; P < .001). No significant difference in postoperative morbidity was observed between the groups before and after propensity score matching (43.5% vs 42.9% [P = .975]; 49.4% vs 41.9% [P = .162]). The complete pathologic response rate of neoadjuvant chemoimmunotherapy was significantly superior to that of chemotherapy alone (27.7% vs 2.0%; P < .001), and no significant difference in postoperative morbidity was observed in neoadjuvant therapy with or without immunotherapy. The neoadjuvant chemoimmunotherapy group also obtained a survival benefit with a 3-year overall survival (79.8% vs 67.5%; P = .001) and a 3-year event-free survival (63.3% vs 41.2%; P = .004).

Conclusions: After neoadjuvant therapy with immunotherapy, pneumonectomy can be safely performed in selected patients without increased postoperative morbidity.