Predictive factors of treatment efficacy and prognosis in patients with resectable non–small cell lung cancer following neoadjuvant chemoimmunotherapy

Abstract Background Non–small cell lung cancer (NSCLC) is the cancer with the highest incidence and mortality rate worldwide. This study aimed to investigate the predictive value of clinicopathological and radiological characteristics for event-free survival (EFS), major pathological response (MPR), and pathological complete response (pCR) in patients with NSCLC undergoing neoadjuvant chemoimmunotherapy. Methods A retrospective analysis was performed on the clinical data of 180 patients with NSCLC who received neoadjuvant chemoimmunotherapy between October 2019 and December 2023. The primary endpoint was EFS, and the secondary endpoint was the pathological response rate. Fisher exact test and the nonparametric Mann-Whitney U test were used to compare categorical and continuous data between the pCR/MPR and non-pCR/non-MPR groups. The Kaplan-Meier method was used to estimate EFS curves, and Cox regression analysis was performed to compare the differences in EFS between patients with or without pCR or MPR. Results Sex ( p = 0.004), smoking history ( p = 0.025), and clinical stage ( p = 0.002) were identified as predictors of pCR and MPR. In our study, pCR was observed in 38.12% and MPR in 44.75% of the patients. Through the multivariate logistic regression model, age and pathological response were found to predict the 1- and 2-year EFS rates, demonstrating satisfactory predictive power (area under the curve, 0.866 and 0.736, respectively). Patients with pCR or MPR exhibited longer EFS compared with those without pCR or MPR, as determined by Cox analysis. Conclusions Sex, smoking history, and clinical stage were identified as predictors of pCR and MPR in patients with NSCLC. Survival analysis revealed that age and pathological response were key prognostic factors for EFS.