322eP Surgical and clinical outcomes of major lung resection post systemic neoadjuvant therapy: A single-center retrospective analysis

Background: Neoadjuvant chemoimmunotherapy has improved outcomes for patients with resectable non-small cell lung cancer (NSCLC), enhancing survival and reducing recurrence.It is emerging as a new standard of care, although the optimal treatment combination and predictive biomarkers remain under investigation.This study aimed to evaluate and compare the efficacy of neoadjuvant treatment strategies in resectable NSCLC based on immune checkpoint inhibitor (ICI) therapy. Methods:Patients with clinical stage IIB-IVA NSCLC who received neoadjuvant chemoimmunotherapy followed by surgical resection at our institution between February 2024 and September 2025 were retrospectively analyzed.Clinicopathologic characteristics, surgical outcomes, and oncologic responses were assessed.Pathologic response, resection margins, and associations with PD-L1 expression were evaluated.Results: 30 patients were included: 22 (73.3%) with stage IIIA-IIIB disease, 2 (6.7%) with stage IIB, and 6 (20.0%) with stage IVA oligometastatic disease.19 patients (63.3%) received nivolumab plus chemotherapy, and 11 (36.7%) received pembrolizumab plus chemotherapy.We performed lobectomy in 17 cases (56.7%), segmentectomy in 4 cases (13.3%), sleeve resection in 3 cases (10%), and pneumonectomy in 6 cases (20%).Major pathological response (MPR) occurred in 19 patients (63.3%), including 13 (43.3%)with a pathological complete response (pCR).R0 resection was achieved in 29 of 30 patients (96.6%).After adjustment for PD-L1 expression, no statistically significant difference in efficacy was observed between nivolumab-and pembrolizumab-based regimens (p = 0.871).PD-L1 expression showed a non-significant trend toward influencing treatment response (p = 0.099). Conclusions:Both nivolumab-and pembrolizumab-based neoadjuvant chemoimmunotherapy demonstrated comparable efficacy and safety in resectable NSCLC.High MPR and R0 resection rates support the feasibility of this approach.Larger, prospective studies with longer follow-up are needed to validate these findings and further refine patient selection and treatment strategies.