Surgical outcomes in patients with non-small cell lung cancer receiving neoadjuvant chemoimmunotherapy versus chemotherapy alone: A systematic review and meta-analysis.

8020 Background: Neoadjuvant immune checkpoint blockade (ICB) including programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1) blockade in combination with chemotherapy has been shown to improve survival outcomes in patients with early-stage non-small cell lung cancer (NSCLC). However, its impact on surgery has not been fully elucidated yet. We aimed to compare surgical outcomes between neoadjuvant chemoimmunotherapy with PD-1/PD-L1 blockade and chemotherapy alone in patients with resectable NSCLC. Methods: We performed a systematic search of PubMed and Embase for randomized-controlled trials (RCTs) that compared neoadjuvant chemoimmunotherapy to chemotherapy alone in patients with resectable NSCLC and reported surgical outcomes including surgical resection rates, R0 resection rates, postoperative complications, any-grade treatment-related adverse events (TRAEs), grade 3-5 TRAEs, serious AEs (SAEs), and AEs leading to cancellation of surgery. Meta-analysis was performed using the random-effects model to pool odds ratios (ORs) of these surgical and safety outcomes. Heterogeneity among the included studies for each outcome was assessed using I 2 statistics and high heterogeneity was defined as I 2 higher than 50%. Results: A systematic review identified 5 RCTs with 2,069 patients for a meta-analysis. All identified RCTs evaluated combination of neoadjuvant PD-1/ PD-L1 blockade with chemotherapy versus chemotherapy alone. Chemoimmunotherapy was associated with an improvement in R0 resection rates (OR 1.72, 95% CI 1.22 - 2.42; p = 0.002), whereas surgical resection rates were comparable between two groups (OR 1.51, 95% CI 0.90 - 2.51; p = 0.12). No significant difference was observed for complication rates, any-grade TRAEs, grade 3-5 TRAEs, SAEs, or AEs leading to cancellation of surgery. (Table). Conclusions: Although the surgical resection rate itself was not significantly different between neoadjuvant chemoimmunotherapy and chemotherapy alone, neoadjuvant chemoimmunotherapy was associated with increased R0 resection rates without an increase in the incidence of complications, TRAEs, and cancellation of surgery. This indicates that neoadjuvant chemoimmunotherapy can be safely administered with an increase in R0 resection rate, which potentially leads to improvement of survival outcomes in patients with resectable NSCLC. [Table: see text]