SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1569864
Efficacy of Neoadjuvant, Adjuvant, and Perioperative Immunotherapy in Non-Small Cell Lung Cancer Across Different PD-L1 Expression Levels: A Systematic Review and Meta-Analysis
Provisionally accepted
- 1Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- 2Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian Province, China
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Background: Immune checkpoint inhibitors, particularly anti-PD-1/PD-L1 monoclonal antibodies, have transformed non-small cell lung cancer (NSCLC) treatment. This meta-analysis evaluates the efficacy of neoadjuvant, adjuvant, and perioperative immunotherapy in resectable NSCLC, stratified by PD-L1 expression levels.We conducted a meta-analysis of 10 randomized controlled trials (RCTs) involving 11 articles, focusing on pathological complete response (pCR), major pathological response (MPR), event-free survival (EFS), and overall survival (OS). These outcomes were stratified by PD-L1 expression levels (<1%, ≥1%, 1-49%, ≥50%).Results: Immunotherapy significantly improved pCR (OR=4.96, 95% CI=2.88-8.57 for PD-L1<1%; OR=9.58, 95% CI=6.32-14.53 for PD-L1≥1%), MPR (OR=2.86, 95% CI=1.97-4.16 for PD-L1<1%; OR=7.39, 95% CI=4.59-11.88 for PD-L1≥1%), and EFS (HR=0.80, 95% CI=0.70-0.92 for PD-L1<1%; HR=0.53, 95% CI=0.45-0.62 for PD-L1≥1%) across all PD-L1 subgroups.Greatest benefits were observed in PD-L1≥50% subgroup, with ORs for pCR and MPR, and HRs for EFS, showing consistent improvements. OS benefits were significant in PD-L1≥1% patients (HR=0.62, 95% CI=0.49-0.79 for PD-L1≥1%) but uncertain in PD-L1<1% cohorts (HR=1.11, 95% CI=0.86-1.44 for PD-L1<1%). Immunotherapy in pPerioperative immunotherapy setting demonstrated robust efficacy, with significant pathological response and EFS benefits across all PD-L1 subgroups.This meta-analysis supports immunotherapy within perioperative care for resectable NSCLC, emphasizing PD-L1 expression as a predictive biomarker. Future studies should optimize patient selection and clarify immunotherapy's role in different treatment settings.
Keywords: PD-L1 Expression and Immunotherapy Efficacy NSCLC, Non-Small Cell Lung Cancer, pCR, Pathological Complete Response, MPR, Major Pathological Response, DFS, disease-free survival, PFS, Progression-free survival, EFS, event-free survival, OS, overall survival, PD-1, programmed cell death protein 1
Received: 02 Feb 2025; Accepted: 21 Apr 2025.
Copyright: © 2025 Zhang, Lin and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Shuchen Chen, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
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