Prognosis and relapse patterns in patients with non-small cell lung cancer with pathologic complete response after neoadjuvant immunochemotherapy.

Background: Although neoadjuvant immunochemotherapy is associated with higher rates of pathologic complete response (pCR) among patients with locally advanced non-small cell lung cancer (NSCLC), data on long-term outcomes after pCR are lacking. Some patients with pCR still experience relapse of disease within a short period of time. Therefore, the aim of this study was to define the long-term survival and relapse patterns in this group of patients. Methods: We retrospectively analyzed patients with stage IB to IIIB NSCLC who had pCR after treatment with immunochemotherapy and surgery at four high-volume medical centers from 2018 to 2022. Survival status and patterns of relapse were determined. Univariable and multivariable analyses were performed to identify risk factors associated with recurrence and survival. Results: In total, 130 patients were included in the study. Median follow-up was 23.3 months. Three-year disease-free survival (DFS) and overall survival (OS) were 84.6% and 93.5%, respectively. Eleven patients had relapse; the median time to relapse was 7.6 months. Six patients had intrathoracic relapse, and 5 had extrathoracic relapse; 1 patient died of progression of disease. Most patients [10/11 (90.9%)] had relapse within 18 months of surgery. On univariable analysis, no factors were associated with risk of relapse. Conclusions: Patients with NSCLC who have pCR after neoadjuvant immunochemotherapy followed by surgery have a good prognosis; however, some patients with pCR experience relapse within a short period of time. This finding suggests that a more comprehensive surveillance protocol may be beneficial for these patients. Molecular testing may be helpful for guiding postoperative therapy and predicting recurrence.