Surgical de-escalation strategies for non-small cell lung cancer following neoadjuvant chemoimmunotherapy: a propensity score-matched analysis
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: 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. Methods: 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). Results: 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). Conclusions: 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.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223803808