Real‐World Outcomes of Induction Immunochemotherapy Followed by Surgery for Advanced Non‐Small Cell Lung Cancer

To evaluate the efficacy, surgical safety, and prognosis of induction immunochemotherapy followed by surgery for advanced nonsmall cell lung cancer (NSCLC). We retrospectively analyzed 143 patients with clinical stage IIB-IVA NSCLC who received induction immunochemotherapy using data from a prospectively maintained database. Survival outcomes were assessed using the Kaplan-Meier method and Cox proportional hazards models. The cohort (N = 143) was predominantly male (92.3%), with clinical stage III-IV (86.7%). Following induction immunochemotherapy, surgical resection was performed in 139 patients (97.2%), with an R0 resection rate of 99.3%. Pathological complete response (pCR) and major pathological response (MPR) rates were 38.8% and 62.6%, respectively, both significantly higher in squamous cell carcinoma (SCC) than in adenocarcinoma (ADC) (p = 0.006). Video-assisted thoracoscopic surgery (VATS) was performed in 87.1% of resections, with a 14.0% conversion rate. Postoperative complications occurred in 33.1% of patients, mostly Clavien-Dindo grade I-II, with no perioperative mortality. At a median follow-up of 23.0 months, the 2-year event-free survival (EFS) and overall survival (OS) rates were 80.1% and 91.8%, respectively. Achieving pCR or MPR and SCC histology were associated with significantly better EFS (p < 0.05). Adjuvant immunotherapy was administered to 59.7% of patients; however, it did not significantly improve survival, regardless of whether patients achieved pCR. Induction immunochemotherapy followed by surgery demonstrates highly effective for advanced NSCLC, achieving encouraging pathological response, favorable survival and a manageable safety profile, particularly in patients with SCC. These results provide a rationale for further prospective validation.