Neoadjuvant chemoimmunotherapy in non-small-cell lung cancer patients: Effects on pulmonary function and incidence of postoperative pulmonary complications–a multicenter real-world study

Abstract OBJECTIVES To evaluate the effects of neoadjuvant chemoimmunotherapy on pulmonary function and the incidence of postoperative pulmonary complications in real-world non-small cell lung cancer patients. METHODS A retrospective analysis of stage II-IIIB non-small cell lung cancer patients who received neoadjuvant chemoimmunotherapy across three medical institutions was conducted. Clinical data and perioperative outcomes were evaluated. RESULTS A total of 386 patients were screened and enrolled in the study cohort, and all patients underwent surgery after completing neoadjuvant chemoimmunotherapy. Postoperatively, 61 patients developed postoperative pulmonary complications, among whom 25 were diagnosed with checkpoint inhibitor-related pneumonia. The postoperative mortality rate was 2.8% (11/386), with all deaths attributed to severe postoperative checkpoint inhibitor-related pneumonia. The diffusing capacity of the lung for carbon monoxide tended to decrease after neoadjuvant chemoimmunotherapy, with 39% of patients developing impaired pulmonary function post-treatment. After controlling for confounding variables via propensity score matching analysis, impaired pulmonary function after treatment was associated with postoperative pulmonary complications. Multivariable logistic regression analysis revealed that prior lung disease (odds ratio, [OR]: 1.63; 95% CI : 1.02–3.31, p = 0.037), impaired pulmonary function after treatment (OR: 2.78; 95% CI: 1.38–5.24, p < 0.001), lymph node metastasis (OR: 3.05; 95% CI: 1.65–6.21, p < 0.001), and elevated preoperative interleukin-6 levels (OR: 1.58; 95% CI: 1.36–1.83, p < 0.001) were high risk factors for postoperative pulmonary complications. CONCLUSIONS Impaired pulmonary function after neoadjuvant chemoimmunotherapy is associated with the development of postoperative pulmonary complications. Post-treatment impaired pulmonary function, lymph node metastasis, prior lung disease, and elevated preoperative interleukin-6 levels are risk factors for postoperative pulmonary complications.