{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:31:59Z","timestamp":1793914319653,"version":"4.8.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ECE-positive patients had significantly worse DFS than ECE-negative counterparts; multivariable analysis confirmed that ECE was an independent prognostic factor for DFS (HR\u00a0=\u00a02.37, 95% CI: 1.28\u20134.41, P\u00a0=\u00a00.006). 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\u00a0=\u00a03.99, 95% CI: 1.59\u201310.02, P\u00a0=\u00a00.003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1799856","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:06:00Z","timestamp":1784095560000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic significance of extracapsular extension in patients with non-small cell lung cancer following neoadjuvant chemoimmunotherapy: a retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Jianing","family":"Qiu","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoling","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linfeng","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinlei","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Daqing Oilfield General Hospital","place":["Daqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Ling","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J 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