Prognostic significance of extracapsular extension in patients with non-small cell lung cancer following neoadjuvant chemoimmunotherapy: a retrospective cohort study.
Non-small cell lung cancer (NSCLC) is a leading cause of oncology-related mortality. Although neoadjuvant chemoimmunotherapy (NCIT) improves pathologic response, disease recurrence remains common. Extracapsular extension (ECE) is recognized as a hallmark of aggressive tumor biology across malignancies; however, its prognostic significance in the NCIT setting remains to be fully elucidated. This study aims to evaluate the impact of ECE on survival outcomes in patients with NSCLC following NCIT.
A total of 104 patients with NSCLC and pathologically confirmed lymph node metastasis who underwent surgery following NCIT were retrospectively enrolled. Kaplan-Meier analysis and Cox proportional hazards regression evaluated the prognostic impact of ECE. To minimize selection bias, propensity score matching (PSM) analyses were performed. Time-dependent receiver operating characteristic (ROC) curves assessed predictive accuracy.
ECE-positive patients had significantly worse DFS than ECE-negative counterparts; multivariable analysis confirmed that ECE was an independent prognostic factor for DFS (HR = 2.37, 95% CI: 1.28-4.41, P = 0.006). Furthermore, integrating ECE status with major pathologic response (MPR) substantially improved the predictive accuracy for 2-year DFS compared to MPR alone (AUC increased from 0.591 to 0.706). Although ECE did not significantly affect OS, lymphovascular invasion (LVI) emerged as independent predictor of OS (HR = 3.99, 95% CI: 1.59-10.02, P = 0.003).
ECE remains a potent driver of recurrence following NCIT; intensified postoperative surveillance is warranted for these patients to enable early detection and management of relapse.
A total of 104 patients with NSCLC and pathologically confirmed lymph node metastasis who underwent surgery following NCIT were retrospectively enrolled. Kaplan-Meier analysis and Cox proportional hazards regression evaluated the prognostic impact of ECE. To minimize selection bias, propensity score matching (PSM) analyses were performed. Time-dependent receiver operating characteristic (ROC) curves assessed predictive accuracy.
ECE-positive patients had significantly worse DFS than ECE-negative counterparts; multivariable analysis confirmed that ECE was an independent prognostic factor for DFS (HR = 2.37, 95% CI: 1.28-4.41, P = 0.006). Furthermore, integrating ECE status with major pathologic response (MPR) substantially improved the predictive accuracy for 2-year DFS compared to MPR alone (AUC increased from 0.591 to 0.706). Although ECE did not significantly affect OS, lymphovascular invasion (LVI) emerged as independent predictor of OS (HR = 3.99, 95% CI: 1.59-10.02, P = 0.003).
ECE remains a potent driver of recurrence following NCIT; intensified postoperative surveillance is warranted for these patients to enable early detection and management of relapse.