Zentralbl Chir 2025; 150(S 01): S78
DOI: 10.1055/s-0045-1809731
Abstracts
Onkologische Thoraxchirurgie

Predictors of Pathologic Response to Neoadjuvant Immunochemotherapy for Resectable Non-Small Cell Lung Cancer

Authors

  • R Zhang

    1   Städtisches Kliinikum Braunschweig, Klinik für Herz-, Thorax- und Gefäßchirurgie, Braunschweig, Deutschland

  • D-T Huynh

    1   Städtisches Kliinikum Braunschweig, Klinik für Herz-, Thorax- und Gefäßchirurgie, Braunschweig, Deutschland

  • A Dellmann

    2   Städtisches Kliinikum Braunschweig, Institut für Pathologie, Braunschweig, Deutschland

  • W Harringer

    1   Städtisches Kliinikum Braunschweig, Klinik für Herz-, Thorax- und Gefäßchirurgie, Braunschweig, Deutschland
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    Background Factors affecting pathologic response to neoadjuvant immunochemotherapy for patients with advanced NSCLC remain poorly defined. We sought to assess the predictors of major and complete pathologic response (MPR and cPR), which are critical for guiding treatment strategies.

    Methods & Materials Between February 2023 and January 2024, 24 patients with resectable advanced NSCLC at our institution received neoadjuvant immunochemotherapy according to the CheckMate-816 (n=20) or KEYNOTE-671 protocols (n=4). Twenty-two patients underwent anatomic lung resection, while 2 were excluded due to disease progression. Clinicopathologic variables and PD-L1 expression (tumor proportion score [TPS] and combined positive score [CPS]) were analyzed as predictors of pathologic response using logistic regression.

    Results The final cohort included 22 patients: 13 men and 9 women, with a mean age of 66 years. Squamous cell carcinoma was found in ten patients (45.5%). Clinical stages were IIB (9.1%, n=2), IIIA (45.5%, n=10), IIIB (36.4%, n=8), and IVA (9.1%, n=2). Surgical procedures included standard lobectomy (22.7%, n=5), extended lobectomy (45.5%, n=10), bi-lobectomy (22.7%, n=5), and pneumonectomy (9.1%, n=2). No postoperative mortalities occurred, though major complications were observed in 4 patients (18.2%). All resections achieved R0 status. A composite pathologic response (MPR/cPR) was observed in 12 patients (54.5%), with cPR achieved in 9 (40.9%). TPS significantly predicted the composite endpoint (MPR/CPR; p =0.020), while CPS showed a nonsignificant trend (p =0.065). In contrast, neither TPS nor CPS predicted cPR alone (p =0.062 and p =0.071, respectively). High PD-L1 expression (TPS ≥50%) also failed to correlate with cPR. Other variables including histology, clinical stage and tumor grading showed no significant associations.

    Conclusion Our results demonstrated a higher cPR rate compared to CheckMate-816 (24%) and KEYNOTE-671 (18.1%) trial, underscoring potential real-world variability. While TPS predicted the composite endpoint of MPR/CPR, robust predictor for cPR remain elusive, suggesting that future studies integrating novel predictors (e.g. circulating tumor DNA) are needed to improve the outcomes of neoadjuvant immunochemotherapy for resectable advanced NSCLC.


     

    Publication History

    Article published online:
    25 August 2025

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