Neoadjuvant targeted therapy versus chemoimmunotherapy in lung adenocarcinoma: A dual-center comparative study of surgical and survival outcomes.

e20071 Background: Although neoadjuvant chemoimmunotherapy (NCI) and targeted therapy (NTT) represent primary therapeutic strategies for locally advanced lung adenocarcinoma, their relative influence on surgical feasibility and long-term prognosis has not been fully elucidated. Methods: This retrospective, two-center investigation analyzed patients with lung adenocarcinoma who received radical resection following NCI (n=97) or NTT (n=105) between January 2020 and December 2022 at the Cancer Hospital CAMS and the First Affiliated Hospital of China Medical University. We compared surgical metrics (minimally invasive approach frequency, thoracotomy conversion rates, and morbidity), pathological response in the tumor bed and regional nodes, and survival outcomes (3-year OS and RFS) between the two cohorts. Results: Relative to the NCI group, the NTT group exhibited a significantly lower conversion rate (8.6% vs. 18.6%, P=0.04), decreased postoperative drainage (180 mL vs. 240 mL, P<0.01), and a reduced incidence of postoperative pneumonia (2.9% vs. 10.3%, P=0.03). While NCI achieved a superior major pathological response rate (9.3% vs. 1.9%, P=0.02), NTT was associated with improved 3rd-year RFS (73.4% vs. 58.6%, P=0.03). This survival advantage for NTT was particularly substantial in the gene mutation-positive subgroup (3rd-year OS: 89.5% vs. 78.9%, P=0.01; 3rd-year RFS: 72.0% vs. 53.7%, P=0.02). Conclusions: In lung adenocarcinoma, NTT facilitates reduced surgical complexity and fewer postoperative complications compared with NCI. Furthermore, NTT offers enhanced long-term survival benefits, especially for patients harboring specific gene mutations.