Prognostic factors for non-small cell lung cancer after neoadjuvant therapy and surgery: a retrospective observational study.

BACKGROUND

Neoadjuvant therapy, given before surgery, improves surgical outcomes and survival in patients with non-small cell lung cancer (NSCLC). However, there is limited research on factors influencing postoperative survival and recurrence. This study aims to identify key prognostic factors following lung resection after neoadjuvant therapy.

METHODS

We analyzed 102 NSCLC cases with preoperative neoadjuvant therapy, excluding 48 due to cancer progression, insufficient clinical data, loss to follow up, or follow-up duration of <1 year. The Kaplan-Meier and multivariable Cox regression model were used to assess prognostic factors for the time from surgery to recurrence or last follow-up [recurrence-free survival (RFS)] and the time from surgery to death from any cause or last follow-up [overall survival (OS)]. Statistical comparisons were performed using -tests for continuous variables and Chi-square tests for categorical variables.

RESULTS

Univariate and multivariate analyses identified pre-neoadjuvant carcinoembryonic antigen (CEA) and neutrophil-to-lymphocyte ratio (NLR) as significant predictors of both RFS [pre-neoadjuvant CEA: hazard ratio (HR) =12.190, 95% confidence interval (CI): 2.236-66.459, P=0.004; pre-neoadjuvant NLR: HR =2.946, 95% CI: 1.325-6.552, P=0.008] and OS (pre-neoadjuvant CEA: HR =3.545, 95% CI: 1.372-9.161, P=0.009; pre-neoadjuvant NLR: HR =3.783, 95% CI: 1.444-9.909, P=0.007) in NSCLC. And these factors were especially predictive in groups of lung squamous cell carcinoma (LUSC) and <10% residual tumor. CEA and NLR were stronger predictors of RFS than OS, with HRs of 7.751 and 5.627, respectively. Smoking was an independent predictor of RFS in LUSC patients (P<0.05). A >50% reduction in tumor size on post-neoadjuvant computed tomography (CT) correlated with minimal pathological response (P<0.05). Age, pre-neoadjuvant CEA, NLR, programmed cell death protein 1 (PD-1) levels, and changes in mediastinal lymph nodes on post-neoadjuvant CT were significantly associated with tumor recurrence (P<0.05).

CONCLUSIONS

Pre-neoadjuvant CEA and NLR are predictors of postoperative survival. Other factors, including tumor size reduction and PD-1 levels, should be considered in clinical decision-making.