Local consolidative therapy extends survival in metastatic NSCLC with oligoresidual disease following first-line immunotherapy, irrespective of PD-L1 expression.
The role of local consolidative therapy (LCT) in metastatic non-small cell lung cancer (mNSCLC) with oligoresidual disease (ORD) after first-line immunotherapy remains undefined. This study evaluated survival outcomes of LCT in this population. We retrospectively analyzed 127 mNSCLC patients lacking EGFR/ALK alterations who developed ORD (≤ 3 organs or ≤ 5 residual lesions) following first-line PD-1/PD-L1 inhibitor therapy at two centers (2019-2025). Patients received LCT (surgery/SABR/MWA/cryoablation/SABT, n = 57) or systemic therapy alone (non-LCT, n = 70). Progression-free survival (PFS) and overall survival (OS) were compared via Kaplan-Meier analysis; multivariate Cox regression identified prognostic factors. LCT significantly prolonged median PFS (14.0 vs. 7.0 months; HR = 0.171, 95% CI: 0.109-0.268; P < 0.001) and OS (27.3 vs. 15.8 months; HR = 0.049, 95% CI: 0.031-0.078; P < 0.001) versus non-LCT. Notably, survival benefits were independent of PD-L1 expression: PD-L1-high (≥ 50%) subgroup: mPFS 15.4 vs. 11.2 months (P = 0.004); mOS 32.8 vs. 22.0 months (P < 0.001). PD-L1-low (< 50%) subgroup: mPFS 14.0 vs. 7.0 months (P < 0.001); mOS 25.4 vs. 13.8 months (P < 0.001). Multivariate analysis confirmed LCT (HR ~ PFS ~ = 0.171, HR ~ OS ~ = 0.049; both P < 0.001) and high PD-L1 (HR ~ PFS ~ = 0.269, HR ~ OS ~ = 0.136; both P < 0.001) as independent protective factors. Grade 3-4 adverse events occurred in 8.8% of LCT patients (pneumothorax/radiation edema). LCT enhances survival in mNSCLC with ORD post-immunotherapy, irrespective of PD-L1 status. These findings support integrating LCT into standard care for immunotherapy-responsive ORD populations.
Authors
Xie Xie, Yan Yan, Wen Wen, Wu Wu, Cheng Cheng, Hu Hu, Xiao Xiao, Luo Luo, Su Su, Ni Ni, Shan Shan, Yao Yao, Huang Huang, Liu Liu, Liu Liu, Weng Weng
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