SynthesisFrontiers in oncology2026
Neoadjuvant versus perioperative immunotherapy in resectable NSCLC: A PD-L1-stratified Bayesian network meta-analysis.
Synthesis in Frontiers in oncology, 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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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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10 authors.
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Abstract
Background: Neoadjuvant immunochemotherapy (NIC) and perioperative immunochemotherapy (PIC) improve outcomes in resectable non-small cell lung cancer (NSCLC), but their relative effects across programmed death-ligand 1 (PD-L1) subgroups remain unclear because head-to-head trials are lacking. This study aimed to compare NIC, PIC, and platinum-based chemotherapy (CT) for event-free survival (EFS) and overall survival (OS), and to compare individual preoperative regimens for pathologic complete response (pCR) and major pathologic response (MPR), across PD-L1 subgroups. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched through 17 January 2026 for randomized trials. Bayesian random-effects network meta-analyses estimated hazard ratios (HRs) for EFS and OS and risk ratios (RRs) for pCR and MPR, with 95% credible intervals (CrIs). Analyses were conducted in R (rjags and gemtc); funnel plots were generated in Stata 17.0. Results: Eight trials (10 publications; 3,608 patients) were included. Six publications were judged to have a low overall risk of bias, whereas four were judged to have some concerns. Among patients with PD-L1 <1%, PIC improved EFS versus CT (HR 0.74, 95% CrI 0.58-0.96), but neither PIC nor NIC improved OS (PIC: HR 0.93, 95% CrI 0.65-1.33; NIC: HR 1.32, 95% CrI 0.67-2.58). Among those with PD-L1 ≥1%, both PIC and NIC improved EFS (PIC: HR 0.51, 95% CrI 0.36-0.72; NIC: HR 0.44, 95% CrI 0.26-0.74) and OS (PIC: HR 0.57, 95% CrI 0.41-0.78; NIC: HR 0.47, 95% CrI 0.25-0.88) versus CT. In PD-L1 ≥50%, NIC was associated with longer EFS versus CT (HR 0.24, 95% CrI 0.06-0.87). In PD-L1 ≥1%, tislelizumab plus CT was associated with higher pCR versus CT (RR 11.07, 95% CrI 5.35-27.31), and camrelizumab plus CT was associated with higher MPR (RR 8.28, 95% CrI 3.58-21.94). Conclusion: Comparative estimates for neoadjuvant and perioperative immunochemotherapy differed by PD-L1 subgroup and outcome. Indirect comparisons and limited certainty preclude firm conclusions about the superiority of either strategy. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261303366.
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