WCLC 2025 - Posters & ePosters-P2.08 .28 Impact of Neoadjuvant Chemoimmunotherapy vs Chemotherapy in Stage III NSCLC: Real-World Analysis From Spanish ReSECT Database

P2.08 .28 Impact of Neoadjuvant Chemoimmunotherapy vs Chemotherapy in Stage III NSCLC: Real-World Analysis From Spanish ReSECT Database

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This study from the Spanish Society of Thoracic Surgery evaluates the real-world effectiveness and safety of neoadjuvant chemoimmunotherapy (nCIT) versus chemotherapy alone (CT) in patients with resectable stage III non-small cell lung cancer (NSCLC). Despite multimodal treatments, stage III NSCLC still shows poor 5-year survival (~50%), prompting the investigation of nCIT, which in clinical trials has shown improved pathological response and survival outcomes.<br /><br />The retrospective analysis utilized prospectively collected data from the national ReSECT registry, including 114 patients (77 nCIT, 37 CT) undergoing anatomical lung resection after neoadjuvant treatment between January 2023 and May 2025. Patients with unresectable disease or incomplete data were excluded. After propensity score matching (34 per group), the study compared pathological complete response (pCR), tumor down-staging, complete (R0) resection rates, surgical complexity, perioperative complications, length of stay, and mortality.<br /><br />Results demonstrated that nCIT significantly improved oncologic outcomes, tripling pCR rates and increasing tumor and nodal down-staging and R0 resections compared to chemotherapy alone. Surgically, nCIT was associated with longer operative times and a higher number of complex procedures like sleeve resections but did not increase major postoperative complications or 30-/90-day mortality.<br /><br />The findings corroborate phase III trial results in a real-world setting, supporting nCIT as a new standard for resectable stage III NSCLC. The study suggests future research focus on linking pathological response to long-term survival, identifying biomarkers for patient selection, and optimizing perioperative care for complex surgeries. Overall, nCIT offers substantial oncologic benefit without compromising surgical safety in this patient population.

Asset Subtitle

Xavier Vaíllo

Meta Tag

Speaker Xavier Vaíllo

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

neoadjuvant chemoimmunotherapy

chemotherapy

stage III non-small cell lung cancer

pathological complete response

tumor down-staging

complete resection

surgical complexity

perioperative complications

real-world study

Spanish Society of Thoracic Surgery