Surgical and Survival Benefits of Neoadjuvant Targeted Therapy vs Chemoimmunotherapy in Lung Adenocarcinoma: A Dual-Center Research.

Abstract

Neoadjuvant chemoimmunotherapy (NCI) and neoadjuvant targeted therapy (NTT) are cornerstone treatments of locally advanced lung adenocarcinoma (LA). However, their impact on surgical feasibility and long-term survival outcomes remains unclear. This dual-center retrospective study included patients with LA who underwent radical surgery after NCI (n = 97) or NTT (n = 105) from January 2020 to December 2022 in the Cancer Hospital Chinese Academy of Medical Sciences and First Affiliated Hospital of China Medical University. Surgical outcomes (minimally invasive surgery rate, conversion to thoracotomy rate, complications), pathologic response of tumor bed and metastatic lymph nodes, and survival outcomes (3-year overall survival and recurrence-free survival) were compared between the groups. Compared with the NCI group, the NTT group had a lower conversion rate (8.6% vs 18.6%; P = .04), reduced postoperative drainage volume (180 mL vs 240 mL; P < .01), and lower incidence of postoperative pneumonia (2.9% vs 10.3%; P = .03). The NCI group demonstrated a higher major pathologic response rate (9.3% vs 1.9%; P = .02). The NTT group achieved superior 3-year recurrence-free survival (73.4% vs 58.6%; P = .03) compared with NCI, with particularly pronounced survival benefits in the gene mutation-positive subgroup (3-year overall survival, 89.5% vs 78.9% [P = .01]; 3-year recurrence-free survival, 72.0% vs 53.7% [P = .02]). For patients with LA, NTT is associated with reduced surgical complexity, lower conversion rates, and fewer postoperative complications compared with NCI. In addition, NTT is correlated with long-term survival benefits, particularly in patients with gene mutations.