ArticleFrontiers in immunology2026
Prognostic significance of extracapsular extension in patients with non-small cell lung cancer following neoadjuvant chemoimmunotherapy: a retrospective cohort study.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Non-small cell lung cancer (NSCLC) is a leading cause of oncology-related mortality. Although neoadjuvant chemoimmunotherapy (NCIT) improves pathologic response, disease recurrence remains common. Extracapsular extension (ECE) is recognized as a hallmark of aggressive tumor biology across malignancies; however, its prognostic significance in the NCIT setting remains to be fully elucidated. This study aims to evaluate the impact of ECE on survival outcomes in patients with NSCLC following NCIT. Methods: A total of 104 patients with NSCLC and pathologically confirmed lymph node metastasis who underwent surgery following NCIT were retrospectively enrolled. Kaplan-Meier analysis and Cox proportional hazards regression evaluated the prognostic impact of ECE. To minimize selection bias, propensity score matching (PSM) analyses were performed. Time-dependent receiver operating characteristic (ROC) curves assessed predictive accuracy. Results: ECE-positive patients had significantly worse DFS than ECE-negative counterparts; multivariable analysis confirmed that ECE was an independent prognostic factor for DFS (HR = 2.37, 95% CI: 1.28-4.41, P = 0.006). Furthermore, integrating ECE status with major pathologic response (MPR) substantially improved the predictive accuracy for 2-year DFS compared to MPR alone (AUC increased from 0.591 to 0.706). Although ECE did not significantly affect OS, lymphovascular invasion (LVI) emerged as independent predictor of OS (HR = 3.99, 95% CI: 1.59-10.02, P = 0.003). Conclusions: ECE remains a potent driver of recurrence following NCIT; intensified postoperative surveillance is warranted for these patients to enable early detection and management of relapse.
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