Association between pretreatment emotional distress and survival outcomes in patients with advanced non–small-cell lung cancer: an individual patient data meta-analysis of 4632 patients in seven trials

Emotional distress (ED) is associated with worse survival outcomes in patients with melanoma and non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). However, several preclinical studies suggest the association between stress and cancer treatment extends beyond ICIs alone. To systematically evaluate the relationship between ED and NSCLC patient prognosis. This study is an individual patient data (IPD) meta-analysis. Relevant studies were identified from the PubMed, Web of Science, The Cochrane Library, Embase, and Vivli databases to obtain IPD up to February 2025. The hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to estimate the association between ED and patient prognosis. Subgroup analysis was conducted based on patient treatment methods. Kaplan-Meier analysis shows that compared with patients without ED, patients with ED had worse survival outcomes, regardless of ICIs or chemotherapy (CT) (HR of overall survival (OS), 1.21 (1.11-1.33), p = 0.01; hazard ratio of progression-free survival (PFS), 1.19 (1.07-1.31), p = 0.01). IPD meta-analysis also supported results above (HR of OS, 1.18, 95% CI, 1.07-1.30; HR of PFS, 1.15, 95% CI, 1.03-1.28). Our research suggests that ED is only a prognostic biomarker in NSCLC, rather than a predictive biomarker for ICIs.