{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T14:07:28Z","timestamp":1772287648584,"version":"3.50.1"},"reference-count":16,"publisher":"IMR Press","issue":"2","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br. J. Hosp. Med. (Lond)"],"abstract":"<jats:p>Aims\/Background: Non-small cell lung cancer (NSCLC) accounts for approximately 80\u201385% of all lung cancers, and lymph node metastasis is a key determinant of patient prognosis, often leading to poorer clinical outcomes. Although immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape of advanced NSCLC, their specific efficacy in patients with lymph node metastases remains unclear. This study aimed to evaluate the efficacy and safety of ICI monotherapy versus chemotherapy in previously treated, unresectable NSCLC patients with lymph node metastasis. Methods: A retrospective analysis was performed on patients with unresectable, previously treated NSCLC with lymph node metastasis who received treatment at Xi\u2019an International Medical Center Hospital between April 2019 and October 2022. Following 1:1 propensity score matching (PSM), 112 patients were included in the final analysis, comprising 56 in the ICI group (treated with pembrolizumab) and 56 in the chemotherapy group (treated with docetaxel). The primary endpoint was objective response rate (ORR), while secondary endpoints included disease control rate (DCR), overall survival (OS), and safety. Results: The ICI group demonstrated a significantly higher ORR compared with the chemotherapy group (50.0% vs. 26.8%, p = 0.012). No significant difference in DCR was observed between the groups (p = 0.057). Kaplan-Meier analysis revealed significantly longer OS in the ICI group (p = 0.009). Multivariate analysis indicated a high risk of death in the chemotherapy group compared to the ICI group (hazard ratio [HR] = 1.796; 95% confidence interval [CI]: 1.112\u20132.900; p = 0.017). In terms of safety, leukopenia occurred more frequently in the chemotherapy group (p = 0.039), while immune-related adverse events (irAEs), including hypothyroidism (p = 0.027) and rash (p = 0.008), were more common in the ICI group. Conclusion: In previously treated patients with unresectable NSCLC and lymph node metastasis, real-world evidence from this study suggests that pembrolizumab monotherapy offers superior efficacy and survival benefits compared with docetaxel chemotherapy. Moreover, the two therapies display distinct safety profiles, with ICI therapy associated with fewer severe hematologic toxicities.<\/jats:p>","DOI":"10.31083\/bjhm50722","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T13:29:12Z","timestamp":1772285352000},"source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer With Lymph Node Metastasis"],"prefix":"10.31083","volume":"87","author":[{"given":"Liangliang","family":"Xue","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Xi\u2019an International Medical Center Hospital, 710000 Xi\u2019an, Shaanxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ru","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Xi\u2019an International Medical Center Hospital, 710000 Xi\u2019an, Shaanxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ge","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Affiliated Hospital of Xi\u2019an Jiaotong University, 710006 Xi\u2019an, Shaanxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenhai","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Xi\u2019an International Medical Center Hospital, 710000 Xi\u2019an, Shaanxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Xi\u2019an International Medical Center Hospital, 710000 Xi\u2019an, Shaanxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Zhou J, Xu Y, Liu J, Feng L, Yu J, Chen D. Global burden of lung cancer in 2022 and projections to 2050: Incidence and mortality estimates from GLOBOCAN. Cancer Epidemiology. 2024; 93: 102693.","DOI":"10.1016\/j.canep.2024.102693"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209\u2013249.","DOI":"10.3322\/caac.21660"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WEE, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. Journal of Thoracic Oncology. 2016; 11: 39\u201351.","DOI":"10.1016\/j.jtho.2015.09.009"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE, et al. Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer. The New England Journal of Medicine. 2015; 373: 1627\u20131639.","DOI":"10.1056\/NEJMoa1507643"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Herbst RS, Morgensztern D, Boshoff C. The biology and management of non-small cell lung cancer. Nature. 2018; 553: 446\u2013454.","DOI":"10.1038\/nature25183"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Zhao B, Zhao H, Zhao J. Efficacy of PD-1\/PD-L1 blockade monotherapy in clinical trials. Therapeutic Advances in Medical Oncology. 2020; 12: 1758835920937612.","DOI":"10.1177\/1758835920937612"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Binnewies M, Roberts EW, Kersten K, Chan V, Fearon DF, Merad M, et al. Understanding the tumor immune microenvironment (TIME) for effective therapy. Nature Medicine. 2018; 24: 541\u2013550.","DOI":"10.1038\/s41591-018-0014-x"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Fridman WH, Zitvogel L, Saut\u00e8s-Fridman C, Kroemer G. The immune contexture in cancer prognosis and treatment. Nature Reviews. Clinical Oncology. 2017; 14: 717\u2013734.","DOI":"10.1038\/nrclinonc.2017.101"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. 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Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet. 2017; 389: 255\u2013265.","DOI":"10.1016\/S0140-6736(16)32517-X"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Socinski MA, Jotte RM, Cappuzzo F, Orlandi F, Stroyakovskiy D, Nogami N, et al. Atezolizumab for First-Line Treatment of Metastatic Nonsquamous NSCLC. The New England Journal of Medicine. 2018; 378: 2288\u20132301.","DOI":"10.1056\/NEJMoa1716948"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Brahmer J, Reckamp KL, Baas P, Crin\u00f2 L, Eberhardt WEE, Poddubskaya E, et al. Nivolumab versus Docetaxel in Advanced Squamous-Cell Non-Small-Cell Lung Cancer. The New England Journal of Medicine. 2015; 373: 123\u2013135.","DOI":"10.1056\/NEJMoa1504627"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Nosaki K, Saka H, Hosomi Y, Baas P, de Castro G, Jr, Reck M, et al. Safety and efficacy of pembrolizumab monotherapy in elderly patients with PD-L1-positive advanced non-small-cell lung cancer: Pooled analysis from the KEYNOTE-010, KEYNOTE-024, and KEYNOTE-042 studies. Lung Cancer. 2019; 135: 188\u2013195.","DOI":"10.1016\/j.lungcan.2019.07.004"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Rizvi NA, Mazi\u00e8res J, Planchard D, Stinchcombe TE, Dy GK, Antonia SJ, et al. Activity and safety of nivolumab, an anti-PD-1 immune checkpoint inhibitor, for patients with advanced, refractory squamous non-small-cell lung cancer (CheckMate 063): a phase 2, single-arm trial. The Lancet. 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