Survival outcomes between neoadjuvant and adjuvant chemo-immunotherapy in patients with stage II–III NSCLC undergoing surgical resection.

8060 Background: In patients with stage II–III NSCLC, perioperative systemic therapy is recommended; however, the optimal timing of chemo-immunotherapy relative to surgery remains an area of active investigation. The aim of this study was to compare overall survival outcomes between neoadjuvant and adjuvant chemo-immunotherapy in patients with stage II–III NSCLC undergoing surgical resection. Methods: We utilized the National Cancer Database (NCDB) and included patients with complete follow-up data, diagnosed between 2018 and 2023 with clinically staged IIA–IIIB NSCLC (cT1–cT4, cN0–cN2, cM0), who underwent definitive surgical resection, and received either neoadjuvant or adjuvant chemo-immunotherapy. Kaplan–Meier analysis and propensity score–adjusted Cox proportional hazards models were used to assess survival outcomes. Results: A total of 2,815 patients met the inclusion criteria, including 1,521 (54%) males, with a median age of 66 years. Of these, 1,186 (42%) patients received neoadjuvant therapy and 1,629 (58%) received adjuvant therapy. Median overall survival (OS) was not reached in the neoadjuvant group, compared with 79.4 months (95% CI, 68.1–90.7, p < 0.001) in the adjuvant group (Table 1). On propensity score–adjusted Cox regression, neoadjuvant therapy was associated with a significant OS advantage compared with adjuvant therapy (HR 0.71; 95% CI, 0.58–0.87; p < 0.001). Neoadjuvant therapy was associated with improved OS among patients with baseline cN2 disease (HR 0.64; 95% CI, 0.45–0.91; p = 0.012). No statistically significant difference in OS was observed among patients with cT3 or cT4 disease (HR 0.95; 95% CI, 0.66–1.36; p = 0.759) and HR 0.67; (95% CI, 0.45–1.01; p = 0.053), respectively. Conclusions: In patients with stage II–III NSCLC undergoing surgical resection, neoadjuvant chemo-immunotherapy was associated with improved overall survival compared with adjuvant therapy, particularly among those with a higher nodal or regional tumor burden at presentation. Median overall survival and hazard ratios for neoadjuvant versus adjuvant chemo-immunotherapy in stage II–III NSCLC. Neoadjuvant Median OS (months) Adjuvant Median OS (months) Hazard Ratio (HR) 95% CI p-value Overall cohort NR 79.4 (68.1–90.7) 0.71 0.58–0.87 <0.001 cN2 NR 62.6 (45.4–79.8) 0.64 0.45–0.91 0.012 cT3 NR 76.3 (62.4–90.1) 0.95 0.66–1.36 0.759 cT4 71.0 (62.7 – 79.3) 56.1 (37.6- 74.5) 0.67 0.45–1.01 0.053