{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:14:08Z","timestamp":1786115648731,"version":"build-2736575974"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"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. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neoadjuvant immunochemotherapy (NIC) and perioperative immunochemotherapy (PIC) improve outcomes in resectable non-small cell lung cancer (NSCLC), but their relative effects across programmed death-ligand 1 (PD-L1) subgroups remain unclear because head-to-head trials are lacking. This study aimed to compare NIC, PIC, and platinum-based chemotherapy (CT) for event-free survival (EFS) and overall survival (OS), and to compare individual preoperative regimens for pathologic complete response (pCR) and major pathologic response (MPR), across PD-L1 subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, the Cochrane Library, and Web of Science were searched through 17 January 2026 for randomized trials. Bayesian random-effects network meta-analyses estimated hazard ratios (HRs) for EFS and OS and risk ratios (RRs) for pCR and MPR, with 95% credible intervals (CrIs). Analyses were conducted in R (rjags and gemtc); funnel plots were generated in Stata 17.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight trials (10 publications; 3,608 patients) were included. Six publications were judged to have a low overall risk of bias, whereas four were judged to have some concerns. Among patients with PD-L1 &amp;lt;1%, PIC improved EFS versus CT (HR 0.74, 95% CrI 0.58\u20130.96), but neither PIC nor NIC improved OS (PIC: HR 0.93, 95% CrI 0.65\u20131.33; NIC: HR 1.32, 95% CrI 0.67\u20132.58). Among those with PD-L1 \u22651%, both PIC and NIC improved EFS (PIC: HR 0.51, 95% CrI 0.36\u20130.72; NIC: HR 0.44, 95% CrI 0.26\u20130.74) and OS (PIC: HR 0.57, 95% CrI 0.41\u20130.78; NIC: HR 0.47, 95% CrI 0.25\u20130.88) versus CT. In PD-L1 \u226550%, NIC was associated with longer EFS versus CT (HR 0.24, 95% CrI 0.06\u20130.87). In PD-L1 \u22651%, tislelizumab plus CT was associated with higher pCR versus CT (RR 11.07, 95% CrI 5.35\u201327.31), and camrelizumab plus CT was associated with higher MPR (RR 8.28, 95% CrI 3.58\u201321.94).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Comparative estimates for neoadjuvant and perioperative immunochemotherapy differed by PD-L1 subgroup and outcome. Indirect comparisons and limited certainty preclude firm conclusions about the superiority of either strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n                      , identifier CRD420261303366.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1905730","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:25:39Z","timestamp":1785990339000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Neoadjuvant versus perioperative immunotherapy in resectable NSCLC: A PD-L1\u2013stratified Bayesian network meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Yi","family":"Jian","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijie","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feihong","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moluyu","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panhong","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cao","family":"Qing","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fashuang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Jinsha County People\u2019s Hospital","place":["Bijie, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,6]]},"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 Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1351359","article-title":"Perioperative immunotherapy for stage II-III non-small cell lung cancer: a meta-analysis base on randomized controlled trials","volume":"14","author":"Yu","year":"2024","journal-title":"Front Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-023-00798-3","article-title":"The global burden of lung cancer: current status and future trends","volume":"20","author":"Leiter","year":"2023","journal-title":"Nat Rev Clin Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1038\/nature25183","article-title":"The biology and management of non-small cell lung cancer","volume":"553","author":"Herbst","year":"2018","journal-title":"Nature"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-023-01295-2","article-title":"Systematic literature review to identify cost and resource use data in patients with early-stage non-small cell lung cancer (NSCLC)","volume":"41","author":"Jovanoski","year":"2023","journal-title":"Pharmacoeconomics"},{"key":"B6","doi-asserted-by":"publisher","first-page":"Cd011430","DOI":"10.1002\/14651858.cd011430","article-title":"Adjuvant chemotherapy for resected early-stage non-small cell lung cancer","volume":"2015","author":"Burdett","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jtho.2015.09.009","article-title":"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","volume":"11","author":"Goldstraw","year":"2016","journal-title":"J Thorac Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2023.11.042","article-title":"Recurrence-free survival in patients with surgically resected non-small cell lung cancer: a systematic literature review and meta-analysis","volume":"165","author":"Rajaram","year":"2024","journal-title":"Chest"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2202170","article-title":"Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer","volume":"386","author":"Forde","year":"2022","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(24)01756-2","article-title":"Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab compared with neoadjuvant chemotherapy alone in patients with early-stage non-small-cell lung cancer (KEYNOTE-671): a randomised, double-blind, placebo-controlled, phase 3 trial","volume":"404","author":"Spicer","year":"2024","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2311926","article-title":"Perioperative nivolumab in resectable lung cancer","volume":"390","author":"Cascone","year":"2024","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2025.105759","article-title":"Immunotherapy for resectable NSCLC: neoadjuvant\/perioperative followed by surgery over surgery followed by adjuvant. Systematic review and meta-analysis with subgroup analyses","volume":"10","author":"Rossi","year":"2025","journal-title":"ESMO Open"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1432813","article-title":"Efficacy and safety of immune checkpoint inhibitors as neoadjuvant therapy in perioperative patients with non-small cell lung cancer: a network meta-analysis and systematic review based on randomized controlled trials","volume":"15","author":"Chen","year":"2024","journal-title":"Front Immunol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2007.13.9030","article-title":"Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group","volume":"26","author":"Pignon","year":"2008","journal-title":"J Clin Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.21037\/tlcr-22-476","article-title":"Comparison of perioperative outcomes among non-small cell lung cancer patients with neoadjuvant immune checkpoint inhibitor plus chemotherapy, EGFR-TKI, and chemotherapy alone: a real-world evidence study","volume":"11","author":"Zhao","year":"2022","journal-title":"Transl Lung Cancer Res"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1200\/jco-24-02239","article-title":"Neoadjuvant nivolumab plus ipilimumab versus chemotherapy in resectable lung cancer","volume":"43","author":"Awad","year":"2025","journal-title":"J Clin Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2304875","article-title":"Perioperative durvalumab for resectable non-small-cell lung cancer","volume":"389","author":"Heymach","year":"2023","journal-title":"N Engl J Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2023.2751","article-title":"Neoadjuvant camrelizumab plus platinum-based chemotherapy vs chemotherapy alone for Chinese patients with resectable stage IIIA or IIIB (T3N2) non-small cell lung cancer: the TD-FOREKNOW randomized clinical trial","volume":"9","author":"Lei","year":"2023","journal-title":"JAMA Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.24735","article-title":"Perioperative toripalimab plus chemotherapy for patients with resectable non-small cell lung cancer: the Neotorch randomized clinical trial","volume":"331","author":"Lu","year":"2024","journal-title":"Jama"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2215530","article-title":"Perioperative nivolumab and chemotherapy in stage III non-small-cell lung cancer","volume":"389","author":"Provencio","year":"2023","journal-title":"N Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1056\/NEJMoa2302983","article-title":"Perioperative pembrolizumab for early-stage non-small-cell lung cancer","volume":"389","author":"Wakelee","year":"2023","journal-title":"N Engl J Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-2600(24)00269-8","article-title":"Perioperative tislelizumab plus neoadjuvant chemotherapy for patients with resectable non-small-cell lung cancer (RATIONALE-315): an interim analysis of a randomised clinical trial","volume":"13","author":"Yue","year":"2025","journal-title":"Lancet Respir Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.6837","article-title":"Neoadjuvant chemo-immunotherapy for early-stage non-small cell lung cancer: a systematic review and meta-analysis","volume":"7","author":"Banna","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1200694","article-title":"Safety and activity of anti-PD-L1 antibody in patients with advanced cancer","volume":"366","author":"Brahmer","year":"2012","journal-title":"N Engl J Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2024.0057","article-title":"Neoadjuvant chemoimmunotherapy for NSCLC: a systematic review and meta-analysis","volume":"10","author":"Sorin","year":"2024","journal-title":"JAMA Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1200690","article-title":"Safety, activity, and immune correlates of anti-PD-1 antibody in cancer","volume":"366","author":"Topalian","year":"2012","journal-title":"N Engl J Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1158\/2159-8290.cd-18-0367","article-title":"Fundamental mechanisms of immune checkpoint blockade therapy","volume":"8","author":"Wei","year":"2018","journal-title":"Cancer Discov"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1038\/nrc3239","article-title":"The blockade of immune checkpoints in cancer immunotherapy","volume":"12","author":"Pardoll","year":"2012","journal-title":"Nat Rev Cancer"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.7326\/m14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann Internal Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Bmj"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-016-1583-7","article-title":"Network meta-analysis: an introduction for clinicians","volume":"12","author":"Rouse","year":"2017","journal-title":"Internal Emergency Med"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"Bmj"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1054","article-title":"Automating network meta-analysis","volume":"3","author":"van Valkenhoef","year":"2012","journal-title":"Res Synth Methods"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X12458724","article-title":"Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials","volume":"33","author":"Dias","year":"2013","journal-title":"Med Decis Making"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.03.016","article-title":"Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial","volume":"64","author":"Salanti","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0076654","article-title":"Graphical tools for network meta-analysis in STATA","volume":"8","author":"Chaimani","year":"2013","journal-title":"PloS One"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026","article-title":"GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables","volume":"64","author":"Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0099682","article-title":"Evaluating the quality of evidence from a network meta-analysis","volume":"9","author":"Salanti","year":"2014","journal-title":"PloS One"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003082","article-title":"CINeMA: An approach for assessing confidence in the results of a network meta-analysis","volume":"17","author":"Nikolakopoulou","year":"2020","journal-title":"PloS Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2011.01.012","article-title":"GRADE guidelines 6. Rating the quality of evidence--imprecision","volume":"64","author":"Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1016\/j.cllc.2021.09.010","article-title":"Design and rationale for a phase III, double-blind, placebo-controlled study of neoadjuvant durvalumab + chemotherapy followed by adjuvant durvalumab for the treatment of patients with resectable stages II and III non-small-cell lung cancer: the AEGEAN trial","volume":"23","author":"Heymach","year":"2022","journal-title":"Clin Lung Cancer"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.1285","article-title":"Neoadjuvant-adjuvant vs neoadjuvant-only PD-1 and PD-L1 inhibitors for patients with resectable NSCLC: an indirect meta-analysis","volume":"7","author":"Zhou","year":"2024","journal-title":"JAMA Netw Open"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1905730\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:25:40Z","timestamp":1785990340000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1905730\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":42,"alternative-id":["10.3389\/fonc.2026.1905730"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1905730","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"article-number":"1905730"}}