{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:39:53Z","timestamp":1791815993875,"version":"4.3.4"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Neoadjuvant therapy combining programmed cell death 1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors with platinum-based chemotherapy has demonstrated significant improvement in pathologic response and survival rates among patients with resectable non\u2013small cell lung cancer (NSCLC). However, it remains controversial whether PD-1 blockade therapy given before and after surgery (neoadjuvant-adjuvant treatment) is associated with better outcomes than when given only before surgery (neoadjuvant-only treatment).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the efficacy and safety associated with neoadjuvant-adjuvant anti\u2013PD-1 and anti\u2013PD-L1 therapy with neoadjuvant-only anti\u2013PD-1 and anti\u2013PD-L1 therapy for patients with resectable NSCLC.<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n A systematic search was conducted across databases including PubMed, Embase, and the Cochrane Library, as well as major oncology conferences, through July 31, 2023.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n Randomized clinical trials comparing neoadjuvant-adjuvant or neoadjuvant-only PD-1 and PD-L1 inhibitor therapy vs chemotherapy alone for patients with resectable NSCLC were selected.<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n \n Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (\n PRISMA<\/jats:ext-link>\n ) reporting guideline, 2 authors independently extracted data. Hazard ratios (HRs) and 95% CIs for event-free survival (EFS) and overall survival (OS) were extracted and then pooled through the generic inverse-variance methods. Relative risks (RRs) for treatment-related adverse events (TRAEs) were derived via the Mantel-Haenszel method. Using chemotherapy as a common comparator, indirect comparisons between neoadjuvant-adjuvant immunotherapy and neoadjuvant-only immunotherapy were conducted using frequentist methods. A random or fixed model was used based on intertrial heterogeneity identified through the Cochran\n Q<\/jats:italic>\n test.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was EFS, with secondary outcomes including OS and TRAEs.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study encompassed 4 trials of neoadjuvant-adjuvant immunotherapy and 1 trial of neoadjuvant-only immunotherapy, involving 2385 patients. Direct meta-analysis revealed significant improvements in EFS for both neoadjuvant-adjuvant and neoadjuvant-only immunotherapy compared with chemotherapy alone. In indirect meta-analysis, the addition of adjuvant immunotherapy to neoadjuvant immunotherapy was not associated with improved EFS (HR, 0.90; 95% CI, 0.63-1.30;\n P<\/jats:italic>\n \u2009=\u2009.59) or OS (HR, 1.18; 95% CI, 0.73-1.90;\n P<\/jats:italic>\n \u2009=\u2009.51) compared with neoadjuvant-only immunotherapy. Moreover, the incidence of any grade of TRAEs significantly increased with the addition of adjuvant immunotherapy (RR, 1.08; 95% CI, 1.00-1.17;\n P<\/jats:italic>\n \u2009=\u2009.04).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This meta-analysis suggests that adding PD-1 or PD-L1 inhibitors in the adjuvant phase to neoadjuvant treatment with PD-1 or PD-L1 inhibitors and chemotherapy may not improve survival outcomes for patients with resectable NSCLC and may be associated with increased adverse events. Future validation of these findings is warranted through head-to-head randomized clinical trials.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.1285","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T11:34:38Z","timestamp":1709811278000},"page":"e241285","source":"Crossref","is-referenced-by-count":67,"title":["Neoadjuvant-Adjuvant vs Neoadjuvant-Only PD-1 and PD-L1 Inhibitors for Patients With Resectable NSCLC"],"prefix":"10.1001","volume":"7","author":[{"given":"Yixin","family":"Zhou","sequence":"first","affiliation":[{"name":"State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China"},{"name":"Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anlin","family":"Li","sequence":"additional","affiliation":[{"name":"State Key Laboratory of 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