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Peer-reviewedCC BY-NC-NDTranslational lung cancer research

Surgical de-escalation strategies for non-small cell lung cancer following neoadjuvant chemoimmunotherapy: a propensity score-matched analysis.

  • Yulong Wang1,2,3,4,5
  • Bengang Hui6
  • Xin Wang1,2,3,4,5
  • Guihu Lin1,2,3,4,5
  • Xun Wang1,2,3,4,5
  • Xiao Li1,2,3,4,5
6 affiliations
  1. 1Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
  2. 2Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China.
  3. 3Research Unit of Intelligence Diagnosis and Treatment in Early Non-small Cell Lung Cancer, Chinese Academy of Medical Sciences, Peking University People's Hospital, Beijing, China.
  4. 4Institute of Advanced Clinical Medicine, Peking University, Beijing, China.
  5. 5Beijing Key Laboratory of Innovative Application of Big Data in Lung Cancer, Peking University People's Hospital, Beijing, China.
  6. 6Department of Thoracic Surgery, Air Force Medical University Tangdu Hospital, Xi'an, China.
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Abstract

Surgical de-escalation holds promise for non-small cell lung cancer (NSCLC) following neoadjuvant chemoimmunotherapy (NACI), but evidence remains scarce. We aimed to assess the safety and clinical outcomes of surgical de-escalation following NACI in central NSCLC. A dual-center retrospective cohort study included 166 patients with locally advanced central NSCLC who received NACI followed by curative surgical resection. Patients were stratified into modified (surgical de-escalation) and unmodified groups. Propensity score matching (PSM) was performed to balance baseline covariates, with standardized mean difference ≤0.1 indicating optimal balance. Primary endpoint comprised event-free survival (EFS), and Secondary endpoints included overall survival (OS), recurrence-free survival (RFS), local recurrence-free survival (LRFS), and health-related quality of life (HRQoL). Survival outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression to estimate hazard ratios (HR) and confidence intervals (CIs). At a median follow-up of 33.9 months, the modified surgery group showed superior 3-year EFS (75.2% vs. 63.4%, HR =0.56, P=0.04) and RFS (73.6% vs. 64.3%, HR =0.51, P=0.03) in the unmatched cohort. After PSM, EFS, RFS, and OS were comparable (all P>0.05); nevertheless, the modified surgery group demonstrated a significantly higher risk of local recurrence (HR =5.39, 95% CI: 1.18-24.61, P=0.03). The incidences of perioperative complications and postoperative dyspnea were consistently lower in the modified group before and after PSM (all P<0.05). For carefully selected central NSCLC patients, surgical de-escalation following NACI was associated with lower postoperative dyspnea scores and yielded comparable oncological outcomes. Rigorous surveillance is warranted due to the heightened risk of local recurrence.

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Cite

BibTeXRIS
BibTeX
@article{wang2026surgical,
  title = {{Surgical de-escalation strategies for non-small cell lung cancer following neoadjuvant chemoimmunotherapy: a propensity score-matched analysis.}},
  author = {Yulong Wang and Bengang Hui and Xin Wang and Guihu Lin and Xun Wang and Xiao Li},
  journal = {Translational lung cancer research},
  year = {2026},
  month = sep,
  doi = {10.21037/tlcr-2026-0911},
  url = {https://europepmc.org/article/MED/42999650},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Surgical de-escalation strategies for non-small cell lung cancer following neoadjuvant chemoimmunotherapy: a propensity score-matched analysis.
AU  - Yulong Wang
AU  - Bengang Hui
AU  - Xin Wang
AU  - Guihu Lin
AU  - Xun Wang
AU  - Xiao Li
PY  - 2026
DA  - 2026/09/29
JO  - Translational lung cancer research
DO  - 10.21037/tlcr-2026-0911
UR  - https://europepmc.org/article/MED/42999650
AB  - Surgical de-escalation holds promise for non-small cell lung cancer (NSCLC) following neoadjuvant chemoimmunotherapy (NACI), but evidence remains scarce. We aimed to assess the safety and clinical outcomes of surgical de-escalation following NACI in central NSCLC. A dual-center retrospective cohort study included 166 patients with locally advanced central NSCLC who received NACI followed by curative surgical resection. Patients were stratified into modified (surgical de-escalation) and unmodified groups. Propensity score matching (PSM) was performed to balance baseline covariates, with standardized mean difference ≤0.1 indicating optimal balance. Primary endpoint comprised event-free survival (EFS), and Secondary endpoints included overall survival (OS), recurrence-free survival (RFS), local recurrence-free survival (LRFS), and health-related quality of life (HRQoL). Survival outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression to estimate hazard ratios (HR) and confidence intervals (CIs). At a median follow-up of 33.9 months, the modified surgery group showed superior 3-year EFS (75.2% vs. 63.4%, HR =0.56, P=0.04) and RFS (73.6% vs. 64.3%, HR =0.51, P=0.03) in the unmatched cohort. After PSM, EFS, RFS, and OS were comparable (all P>0.05); nevertheless, the modified surgery group demonstrated a significantly higher risk of local recurrence (HR =5.39, 95% CI: 1.18-24.61, P=0.03). The incidences of perioperative complications and postoperative dyspnea were consistently lower in the modified group before and after PSM (all P<0.05). For carefully selected central NSCLC patients, surgical de-escalation following NACI was associated with lower postoperative dyspnea scores and yielded comparable oncological outcomes. Rigorous surveillance is warranted due to the heightened risk of local recurrence.
SN  - 2218-6751
SN  - 2226-4477
ER  -