Retrospective study of neoadjuvant immunochemotherapy versus chemotherapy in limited-stage small-cell lung cancer

The efficacy of neoadjuvant immunochemotherapy (NIC) in limited-stage small cell lung cancer (LS-SCLC) is undefined. A retrospective study at Peking University People’s Hospital (China) evaluated the pathological and survival outcomes of NIC versus neoadjuvant chemotherapy (NC) and compared NIC with upfront surgery in a real-world setting. The study included patients who underwent upfront surgery or neoadjuvant treatment followed by radical surgery from 2005 to 2025. Propensity score matching (1:2) was used to compare the survival outcomes between the neoadjuvant and upfront surgery cohorts. Among 164 included patients, 45 received neoadjuvant therapy (25 NIC, 20 NC). The NIC group achieved significantly higher pathological complete response (pCR; 52.0% versus 5.0%; OR 19.31; p<0.001) and major pathologic response (MPR; 76.0% versus 15.0%; OR 16.47; p<0.001) rates compared to NC. Rates of nodal downstaging were also superior with NIC. Surgical safety was comparable between NIC and NC. Within the neoadjuvant cohort, achieving pCR or MPR was associated with significantly improved disease-free survival (DFS). After PSM adjustment, the NIC group demonstrated significantly better DFS compared to the upfront surgery group (p=0.007) with a trend toward improved overall survival. The authors conclude that in LS-SCLC, NIC induces significantly deeper pathological responses than NC, translating into a promising DFS advantage over upfront surgery (graphical abstract).