B80-4-42 Safety and Efficacy of Perioperative Chemo-Immunotherapy in Resectable Nsclc: A Systematic Review and Meta-Analysis

Rationale Perioperative immunotherapy aims to enhance systemic tumor eradication by integratingneoadjuvant and adjuvant checkpoint inhibition with chemotherapy, targeting micrometastaticdisease and improving long-term outcomes in resectable NSCLC. This combined strategy mayoptimize immune priming before surgery and sustain antitumor activity postoperatively,surpassing the limited benefit of chemotherapy alone. Methods Randomized Controlled trials (RCTs) comparing perioperative chemo-immunotherapy vschemotherapy were analyzed using Stata 18.0. Risk of bias, assessed by RoB 2.0. Results Seven randomized controlled trials comprising 3,216 patients were analyzed (1,604 treatment;1,612 controls; male = 2,199; female = 1,017). Event-free survival favored immunotherapy (HR0.59; 95% CI 0.52-0.66), with 24-month rates 62.4% vs 40.6%. Pathologic complete response was18.6% vs 3.8% (OR 6.8; 95% CI 4.9-9.4), and major pathologic response 32.8% vs 11.4% (OR3.9; 95% CI 2.8-5.5). Overall survival improved (HR 0.75; 95% CI 0.61-0.92). Surgical resectionoccurred in 82.3% vs 79.5% (RR 1.04; 95% CI 0.98-1.09). Grade ≥3 treatment-related adverseevents were 40.1% vs 37.9% (RR 1.06; 95% CI 0.92-1.22). Immune-related toxicities, includingpneumonitis (3.5% vs 1.2%; RR 2.91; 95% CI 1.32-6.41) and hepatitis (2.1% vs 0.9%; RR 2.33;95% CI 1.04-5.19), were higher with immunotherapy but largely grade 1-2 and reversible.Perioperative mortality remained low (0.8% vs 0.7%; RR 1.14; 95% CI 0.45-2.85). Overall safetyand surgical feasibility were maintained without excess postoperative complications. Conclusion Perioperative chemo-immunotherapy markedly improves survival and pathological response inresectable NSCLC without increasing toxicity or compromising surgical outcomes. Risk of Biaswas low.