Characteristics of patients with resectable early-stage non–small cell lung cancer treated with neoadjuvant chemoimmunotherapy or surgery ± adjuvant therapy.

8061 Background: The integration of immune checkpoint inhibitors (ICIs) into neoadjuvant, perioperative, and adjuvant treatment strategies for early-stage NSCLC (eNSCLC) has been associated with improved patient outcomes; however, despite these advances, uptake of ICIs in the neoadjuvant/perioperative setting remains limited. This study aimed to characterize differences in patient characteristics between those receiving neoadjuvant chemoimmunotherapy (neoadjuvant ICI+CTx) and those receiving upfront surgery ± adjuvant therapy. Methods: Adult patients with stage II-IIIB(N2) NSCLC (AJCC 8 th edition) diagnosed between March 2022 and six months before data cut-off (November 2025) were identified in the Flatiron Health database. Patients who received ICI+CTx prior to surgery were assigned to the neoadjuvant ICI+CTx group, and patients that underwent upfront resection following an NSCLC diagnosis with no previous treatment, with or without adjuvant therapy, were assigned to the surgery± adjuvant therapy group. The Pearson chi-square or fisher exact tests were conducted to evaluate differences in baseline characteristics. All statistical analyses were two-sided. Results: A total of 1,807 patients were identified with resectable stage II-IIIB(N2) NSCLC, of which 204 (11%) initiated neoadjuvant ICI+CTx and 1,603 (89%) received surgery± adjuvant therapy (583 (36%) with adjuvant therapy; 1,020 (64%) without adjuvant therapy). Of the 204 patients, 144 (71%) underwent surgery and 76 (53% of those undergoing surgery) subsequently received adjuvant therapy. Significant differences were observed in the baseline characteristics between the two groups. Patients who received neoadjuvant ICI+CTx had higher proportion of stage III disease, cN2 status, evenly split histology, higher biomarker (PD-L1, EGFR) testing, PD-L1 positive expression levels, and fewer EGFR mutations while patients who received surgery± adjuvant therapy had higher proportion of stage II disease, cN0 status, non-squamous histology, lower biomarker testing, negative or low PD-L1 expression levels, and higher EGFR mutations (all p < 0.001). Conclusions: Despite the clear benefit across clinical trials of neoadjuvant and perioperative ICI strategies to treat resectable eNSCLC, their utilization in clinical practice remains limited. This study further demonstrates significant differences in baseline characteristics that might contribute to patient selection for neoadjuvant ICI+CTx versus upfront surgery ± adjuvant therapy as a primary therapeutic approach. Tailored interventions to further educate the medical community on recent clinical trial evidence may facilitate wider implementation of neoadjuvant and perioperative ICI strategies and broaden appropriate patient selection in resectable eNSCLC.