What question did this study set out to answer?

This study aims to assess the association between pathologic complete response (pCR) and survival outcomes in resectable non-small cell lung cancer (NSCLC) after neoadjuvant immunotherapy.

March 21, 2026ESMO Open0 citationsOpen Access

231P The efficacy of adjuvant EGFR-TKI therapy for stage IA non-small cell lung cancer with EGFR mutations: A retrospective cohort study

YZY. ZhangSichuan University ZLZ. LiuSichuan University QYQ. YuanChinese Academy of Medical Sciences & Peking Union Medical College

Key Points

This study aims to assess the association between pathologic complete response (pCR) and survival outcomes in resectable non-small cell lung cancer (NSCLC) after neoadjuvant immunotherapy.
Conducted a systematic review of studies from PubMed, Embase, and Cochrane Library according to PRISMA guidelines.
Included both prospective trials and retrospective cohort studies reporting pCR with survival outcomes in NSCLC.
Extracted data on pCR definitions, major pathologic response (MPR), and various survival metrics like disease-free survival (DFS) and overall survival (OS).
Assessed risk of bias using ROBINS-I.
A total of 23 studies with 3,487 patients were included.
pCR rates ranged from 6% to 38%, with higher rates observed after chemo-immunotherapy.
Patients with pCR showed better survival outcomes, with 2-year DFS rates between 85% and 92%, compared to 55%-70% for non-pCR patients.
Recurrence occurred in 8-15% of pCR patients, mainly as distant relapses.
Heterogeneity in pCR definitions and assessment methods affects the validity of pCR as a standalone endpoint.

Abstract

Background: Pathologic complete response (pCR) is utilized more frequently as an endpoint in neoadjuvant immunotherapy trials for resectable non-small cell lung cancer (NSCLC).Its utility as a surrogate for long-term survival, however, remains debated.We conducted a systematic review to evaluate the association between pCR and survival outcomes in this setting. Methods:We performed a systematic search of PubMed, Embase and Cochrane Library, according to PRISMA guidelines.We included prospective trials and retrospective cohort studies that either with or without chemotherapy reporting pathologic complete response (pCR) after neoadjuvant immunotherapy in resectable nonsmall cell Lung cancer (NSCLC) with survival outcomes.We extracted data on definitions of pCR, major pathologic response (MPR), disease-free survival (DFS), eventfree survival (EFS), overall survival (OS), and patterns of recurrence.We used ROBINS-I to assess risk of bias.Results: A total of 23 studies with 3,487 patients were included.The reported pCR rates were between 6% and 38%, with higher and consistent pCR rates after chemo-immunotherapy regimens.Patients achieving pCR demonstrated improved survival outcomes, with pooled 2-year DFS rates of 85-92%, compared with 55-70% in non-pCR patients.Despite favorable prognosis, recurrence after pCR was reported in 8-15% of cases, predominantly as distant relapse.Correlation between pCR and OS was limited by short follow-up in most studies.Notably, several studies reported a similar or stronger association between MPR and survival compared with pCR.Substantial heterogeneity was observed in pathological assessment methods and pCR definitions.Conclusions: pCR is associated with improved survival following neoadjuvant immunotherapy in resectable NSCLC, supporting its prognostic relevance.Despite pCR, recurrence occurs, and the heterogeneity of pathologic evaluation limits the validity of pCR as a solitary surrogate endpoint.The combination of pCR with MPR and other clinical or molecular variables may thus offer a more solid framework for outcome prediction.

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