Feasibility and Early Outcomes of Surgery After Neoadjuvant Chemoimmunotherapy in Locally Advanced Non–Small Cell Lung Cancer

Feasibility and Early Outcomes of Surgery After Neoadjuvant Chemoimmunotherapy in Locally Advanced Non–Small Cell Lung Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility and Early Outcomes of Surgery After Neoadjuvant Chemoimmunotherapy in Locally Advanced Non–Small Cell Lung Cancer Gizem Özçıbık Işık, Ezgi Nilay Yağcı Kazanasmaz, Umut Kilimci, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8588919/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Introduction: Treatment approaches for locally advanced non–small cell lung cancer (NSCLC) require multidisciplinary evaluation. In recent years, the addition of immunotherapy to neoadjuvant chemotherapy has been reported to increase pathological response rates. This study aimed to compare surgical feasibility and early outcomes in patients with locally advanced NSCLC who received neoadjuvant chemotherapy or neoadjuvant chemoimmunotherapy and subsequently underwent anatomical lung resection. Methods Patients who underwent surgery for locally advanced (Stage IIB–IIIB, 9th TNM) NSCLC in our clinic between January 2024 and September 2025 were retrospectively evaluated. Patients who received neoadjuvant chemotherapy were classified as Group A, while those who received neoadjuvant chemoimmunotherapy were classified as Group B. Clinical, surgical, and pathological data were compared using univariate and multivariate analyses. Results A total of 76 patients were included in the study; 47 (61.8%) received neoadjuvant chemotherapy and 29 (38.2%) received neoadjuvant chemoimmunotherapy. Demographic characteristics were similar between the groups. Operation time was significantly longer in Group A (p = 0.005). Minimally invasive surgery (VATS) was performed at a significantly higher rate in Group B (p = 0.02). The postoperative pathological T stage was earlier in Group B (p = 0.019), and the pathological complete response rate was significantly higher in the chemoimmunotherapy group (p = 0.001). Although postoperative complication rates were similar between the groups, 30- and 90-day mortality rates were higher in Group B in univariate analysis. No significant difference was observed between the groups in terms of median survival (p = 0.353). Conclusion Neoadjuvant chemoimmunotherapy followed by surgery is a technically safe and feasible approach for patients with locally advanced non–small cell lung cancer. The addition of immunotherapy to neoadjuvant chemotherapy provides a significant pathological advantage, as evidenced by higher pathological complete response rates and earlier pathological T-stage compared with chemotherapy alone. These findings support the role of neoadjuvant chemoimmunotherapy in improving tumor regression and pathological downstaging without compromising surgical feasibility. However, careful patient selection and close postoperative follow-up are warranted due to the observed early mortality. Larger prospective, randomized studies with longer follow-up are required to clarify the impact of neoadjuvant chemoimmunotherapy on long-term survival outcomes. Neoadjuvant chemoimmunotherapy Locally advanced non-small cell lung cancer Video-assisted thoracoscopic surgery Perioperative outcomes Surgical feasibility Pathological response Figures Figure 1 Figure 2 Background Non–small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide and represents the most common lung cancer subtype. 1 The 9th TNM staging system is used for disease staging. 2 According to this system, patients classified as stage IIB, IIIA, and IIIB are defined as having locally advanced disease, for whom treatment modalities vary and multidisciplinary evaluation is required. 2 , 3 The primary aims of neoadjuvant treatments administered before surgery are to achieve tumor regression, thereby allowing more limited lung resections (e.g., sleeve lobectomy or lobectomy instead of pneumonectomy), to eliminate invasion of major vessels and adjacent organs to improve resectability, to eradicate mediastinal lymph node involvement in patients with N2 disease, rendering them suitable for surgical intervention, and to eliminate occult systemic micrometastatic disease. 4 – 8 The literature demonstrates that surgery can be safely performed following neoadjuvant chemotherapy and radiotherapy, with favorable short- and long-term outcomes. 9 , 10 In recent years, immunotherapy agents have also gained a role in the treatment of locally advanced NSCLC. 11 Immune checkpoint inhibitors (ICIs), including programmed cell death protein-1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors, activate the antitumor immune response of T cells by blocking PD-1/PD-L1 binding and preventing tumor immune escape. 12 , 13 Clinical trials such as CheckMate-816 (nivolumab), KEYNOTE-671 (pembrolizumab), and IMpower030 (atezolizumab) have shown that the addition of immunotherapy to neoadjuvant chemotherapy regimens (cisplatin plus pemetrexed or carboplatin plus paclitaxel) improves overall survival. 5 – 7 Compared with chemotherapy and radiotherapy, immunotherapy agents have a more favorable adverse event profile and provide a more durable antitumor effect. 14 Neoadjuvant chemotherapy has been reported to increase postoperative complication rates, 30-day mortality, and readmission rates, and it requires caution during surgery due to treatment-related tissue changes. 15 – 17 Similarly, neoadjuvant chemo-immunotherapy may lead to tissue alterations and changes in pulmonary function, presenting various surgical challenges; nevertheless, the feasibility of surgery following neoadjuvant chemo-immunotherapy has been demonstrated. 18 – 21 For these reasons, the present study aimed to compare patients with locally advanced NSCLC who received neoadjuvant chemotherapy or neoadjuvant chemo-immunotherapy and subsequently underwent anatomical lung resection with systematic lymph node dissection, and to evaluate the early surgical outcomes following neoadjuvant chemo-immunotherapy. Methods Ethical committee approval for this study was obtained from our institution (Non-Interventional Clinical Research Ethics Committee of Istanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital; Date:25.12.2025; Number:2025-1). Patients who underwent surgery for non–small cell lung cancer at our clinic between January 2024 and September 2025 were included in the study. The inclusion criteria were a diagnosis of locally advanced disease (stage IIB, IIIA, or IIIB) according to the 9th TNM staging system at initial presentation and undergoing surgical resection following neoadjuvant treatment. Patients who received radiotherapy and demonstrated disease progression were excluded. Patient data were evaluated retrospectively. A total of 76 patients met the inclusion criteria; 47 patients received neoadjuvant chemotherapy (61.8%), and 29 patients received neoadjuvant chemo-immunotherapy (38.2%). The clinical, surgical, and pathological characteristics of patients who underwent neoadjuvant chemotherapy followed by surgery (Group A) and neoadjuvant chemo-immunotherapy followed by surgery (Group B) were compared. In our routine clinical practice, patients initially diagnosed with locally advanced disease undergo clinical staging, pathological confirmation, and invasive mediastinal staging (endobronchial ultrasound [EBUS], endoscopic ultrasonography (EUS), videomediastinoscopy, video-assisted mediastinoscopic lymphadenectomy [VAMLA] or mediastinotomy), followed by evaluation in a multidisciplinary lung cancer board to determine eligibility for neoadjuvant treatment. In our study, in accordance with the CheckMate-816 trial criteria, immunotherapy was planned for patients who were EGFR- and ALK-negative and had a PD-L1 expression level greater than 1%. In our healthcare system, immunotherapy is administered to patients with adenocarcinoma histology when PD-L1 expression is greater than 1%, whereas in patients with squamous cell carcinoma histology, immunotherapy is administered regardless of PD-L1 status. Accordingly, PD-L1 expression levels were not available for all patients. All patients in the chemo-immunotherapy group received nivolumab as the immunotherapy agent. After completion of the neoadjuvant treatment protocol, patients are re-evaluated clinically and radiologically by the multidisciplinary board. Patients without radiological or metabolic disease progression, or those demonstrating regression, and deemed resectable undergo re-mediastinal staging, after which surgical resection is planned. Surgery is typically scheduled approximately 4–6 weeks after the final dose of neoadjuvant treatment. Statistical analyses were performed using SPSS software (version 27.00; IBM Corp., Armonk, NY, USA). Descriptive statistics were summarized as numbers and percentages for categorical variables and as mean, standard deviation, minimum, and maximum values for parametric variables. Associations between categorical variables were assessed using the chi-square (χ²) test or Fisher’s exact test, as appropriate. Continuous variables were analyzed using Student’s t-test or the Mann–Whitney U test. In multivariate analyses, parametric variables were evaluated using linear regression, whereas categorical variables were analyzed using binary logistic regression. Survival analysis was performed using the Kaplan–Meier method, with comparisons conducted using the log-rank test. Disease-free survival (DFS) was defined as the time from surgery to the first documented occurrence of local recurrence, locoregional recurrence, distant metastasis, or death from any cause. Multivariate survival analysis was carried out using Cox proportional hazards regression. A p value of less than 0.05 was considered statistically significant. Results Our study included 76 patients; 47 patients received neoadjuvant chemotherapy (61.8%), and 29 patients received neoadjuvant chemo-immunotherapy (38.2%). Among patients receiving neoadjuvant chemotherapy, 42 (89.4%) were male, while 26 patients (89.7%) in the neoadjuvant chemo-immunotherapy group were male. The mean age was 62.7 ± 8.2 years in Group A and 62.9 ± 6.3 years in Group B. There were no statistically significant differences in demographic characteristics between the groups (p=0.968 and p=0.233, respectively; Table 1). In univariate analysis, smoking pack-years and FEV1 percentage were significantly lower in Group B, whereas hemoglobin levels were significantly higher (p=0.016, p<0.001, and p=0.010, respectively; Table 2). Operation duration was significantly longer in Group A (p=0.005). Minimally invasive surgery using video-assisted thoracoscopic surgery (VATS) was performed significantly more frequently in Group B, while no statistically significant difference was observed in conversion rates to open surgery between the groups (p=0.02 and p=0.584, respectively; Table 2). The groups had similar TNM characteristics regarding staging before neoadjuvant treatment and prior to surgical intervention (Table 2). Postoperative pathological T stage was significantly earlier in Group B, and the pathological complete response rate was significantly higher in this group (p=0.019 and p=0.001, respectively). The incidence of vascular invasion was significantly higher in Group A (p=0.004). Although postoperative complication rates were comparable between the groups, 30- and 90-day mortality rates were higher in Group B in univariate analysis (p=0.236 and p=0.024, respectively). The most common postoperative complications were atrial fibrillation, prolonged air leak, pneumonia, and wound infection. The cause of 30-day mortality was pneumonia followed by acute respiratory failure (Table 2). In multivariate analysis, operation time was significantly shorter in Group B (p=0.016; RR: 0.5; 95% CI: 0.1–0.9). Minimally invasive surgery using a VATS approach was performed 13.7 times more frequently in Group B (p=0.027; 95% CI: 1.4–16.9). Pathological complete response was 4.5 times more frequent in Group B (p=0.034; 95% CI: 0.1–17.0). The mean follow-up duration was 22.3 ± 1.2 months. Mean survival was 19.8 ± 0.9 months in Group A and 17.4 ± 1.4 months in Group B, with no statistically significant difference between the groups (p=0.353; Table 3 and Figure 1). In multivariate survival analysis, pathological T stage, vascular invasion, and pathological complete response were not statistically significant predictors of survival (p=0.985, p=0.265, and p=0.951, respectively). Disease-free survival (DFS) analysis demonstrated a numerically higher DFS in the neoadjuvant chemo-immunotherapy group compared with the neoadjuvant chemotherapy group. The 1-year DFS rate was 74.5% in patients who received neoadjuvant chemotherapy and 86.2% in those who received neoadjuvant chemo-immunotherapy. Mean DFS was 16.4 months (95% CI: 14.0–18.7) in the neoadjuvant chemotherapy group and 18.4 months (95% CI: 16.2–20.6) in the neoadjuvant chemo-immunotherapy group. However, the difference in DFS between the two groups did not reach statistical significance (p = 0.249) (Table 4, Figure 2). Discussion Our study demonstrates that surgery following neoadjuvant chemo-immunotherapy is technically feasible, is associated with higher rates of minimally invasive surgery, and results in significantly increased pathological complete response rates. One of the primary goals of neoadjuvant therapy is to increase resectability by achieving tumor regression and to allow for more limited lung resections. 5 – 7 Recent studies have shown that neoadjuvant protocols, particularly those incorporating immune checkpoint inhibitors (ICIs), significantly improve pathological response rates. 5 – 7 In the CheckMate-816 trial, the pathological complete response rate was reported as 24% in the neoadjuvant nivolumab plus chemotherapy arm, compared with 2.2% in the chemotherapy-only arm [5]. The significantly higher pathological complete response rate observed in the chemo-immunotherapy group in our study is consistent with the existing literature and further supports the efficacy of neoadjuvant immunotherapy. Furthermore, the higher rate of video-assisted thoracoscopic surgery (VATS) in the chemo-immunotherapy group and the absence of a difference in conversion rates to open surgery suggest that immunotherapy does not render surgical dissection technically prohibitive. In a previous study conducted at our institution, the conversion rate from minimally invasive surgery to open surgery was 4.7%, whereas this rate was observed to be higher in patients who received neoadjuvant chemotherapy or chemo-immunotherapy [18]. Ostrovetsky et al. reported increased surgical difficulty due to fibrosis and hilar–mediastinal adhesions following immunotherapy. 19 Similarly, Mitsudomi et al. highlighted these technical challenges but demonstrated that minimally invasive surgery can be safely performed after neoadjuvant chemo-immunotherapy in experienced centers. 21 In our clinic, the accumulated experience of our surgical team with minimally invasive approaches following neoadjuvant chemotherapy and the completion of the learning curve may have contributed to the more frequent use of minimally invasive techniques after chemo-immunotherapy. Additionally, increased experience with hilar and mediastinal dissection in patients undergoing surgery after neoadjuvant chemotherapy may explain the comparable conversion rates from VATS to thoracotomy between the groups. For these reasons, we believe that surgical procedures following neoadjuvant chemo-immunotherapy can be performed safely and minimally invasively by experienced surgical teams. The longer operation time observed in the neoadjuvant chemotherapy group may be related to more advanced fibrotic changes, a higher incidence of vascular invasion, and increased rates of open surgery in this group. In contrast, the significantly shorter operation time in the chemo-immunotherapy group in multivariate analysis may be explained by better tumor regression and earlier pathological T stage. These findings suggest that neoadjuvant chemo-immunotherapy is at least as favorable as chemotherapy from a surgical perspective and may even be advantageous in selected cases. In our study, the earlier pathological T stage and lower frequency of vascular invasion observed in the chemo-immunotherapy group support the favorable effect of immunotherapy on tumor biology. 5–7,12−14 Although previous studies have demonstrated an association between pathological complete response and long-term survival, we were unable to observe a survival benefit in our cohort, likely due to the relatively short follow-up period. 5 – 7 With the completion of longer-term follow-up, the positive impact of pathological complete response on survival may become more apparent. While postoperative complication rates were similar between the two groups, it is noteworthy that 30- and 90-day mortality rates were higher in the chemo-immunotherapy group in univariate analysis but did not remain statistically significant in multivariate analysis. This finding may be related to subclinical pulmonary toxicity associated with immunotherapy, the risk of immune-related pneumonitis, and a lower preoperative respiratory reserve, as reflected by the significantly reduced preoperative pulmonary function parameters—particularly FEV1 percentages—observed in the chemo-immunotherapy group. In addition, baseline laboratory findings in this group, including lower hemoglobin levels and altered inflammatory markers, may indicate a more fragile physiological status, potentially predisposing these patients to adverse early postoperative outcomes. Although increased early mortality following neoadjuvant immunotherapy has not been clearly demonstrated in the literature, these results underscore the importance of careful patient selection, particularly with respect to pulmonary function, baseline physiological reserve, and the risk of immune-related adverse effects. 12 – 14 The loss of statistical significance in multivariate analysis further suggests that the observed mortality difference may primarily reflect selection bias related to the retrospective study design and baseline differences in respiratory reserve and laboratory parameters rather than a direct effect of chemo-immunotherapy itself. No significant difference in median survival was observed between the groups. However, the relatively short mean follow-up period may have limited our ability to assess the long-term survival benefit of neoadjuvant chemo-immunotherapy. This finding may also be influenced by the limited sample size and heterogeneous stage distribution. Additionally, the lack of significance for pathological T stage, vascular invasion, and pathological complete response in the multivariate survival analysis further suggests that the study may be underpowered. Larger studies with longer follow-up durations are required to more clearly define the survival impact of neoadjuvant chemo-immunotherapy. In terms of disease-free survival, the neoadjuvant chemo-immunotherapy group demonstrated numerically higher DFS rates compared with the neoadjuvant chemotherapy group. Although both the 1-year DFS rate and median DFS favored the chemo-immunotherapy group, this difference did not reach statistical significance. This finding may be attributed to the relatively short follow-up period, limited sample size, and heterogeneous stage distribution of the study population. Given that DFS is often an earlier and more sensitive endpoint for treatment efficacy than overall survival, longer follow-up may reveal a more pronounced separation between the survival curves, particularly in favor of neoadjuvant chemo-immunotherapy. 5 – 9 The main limitations of our study include its retrospective design, single-center setting, potential selection bias in surgical decision-making, relatively small sample size, and limited follow-up period. Moreover, the heterogeneity of immunotherapy regimens, the absence of PD-L1 expression and molecular mutation data in all patients, and the inability to assess the impact of these biomarkers on pathological response and clinical outcomes limit the generalizability of our findings. Conclusion In conclusion, surgery following neoadjuvant chemo-immunotherapy is a safe and feasible approach in patients with locally advanced NSCLC. Notably, the addition of immunotherapy to neoadjuvant chemotherapy resulted in a significantly higher pathological complete response rate and earlier pathological T stage, highlighting the oncologic advantage of chemo-immunotherapy in terms of tumor regression and pathological downstaging. Although early postoperative mortality warrants careful patient selection and close postoperative follow-up, neoadjuvant chemo-immunotherapy appears to provide meaningful pathological benefit without compromising surgical feasibility. Prospective, randomized studies with longer follow-up and biomarker-driven stratification are needed to clarify its impact on long-term survival outcomes. Declarations Ethics approval and consent to participate: Ethical committee approval was obtained for the study (Non-Interventional Clinical Research Ethics Committee of Istanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital; Date:25.12.2025; Number:2025-1). Participation was voluntary, and informed consent was obtained from all respondents. This study was conducted in accordance with the principles of the Declaration of Helsinki. Clinical trial number Not applicable. Consent for publication: Not applicable. Conflicts of interest/Competing interests: Authors have no conflicts of interest or financial ties to disclose. Funding: No source of funding or research and/or publication. Authors declare they have nothing to disclose. Author Contribution GÖI, ENYK, UK, MVD, CBS, LC, and ÖS designed the study, acquired and analyzed data and approved its final version. Data Availability The data in the study are available for consultation. References Jiang P, Chen W, Zheng G, Li X, Song X. Non-small cell lung cancer subtype classification based on cross-scale multi-instance learning. Sci Rep. 2025;15(1):43210. Rami-Porta R, Nishimura KK, Giroux DJ, et al. 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Comparisons between groups were performed using Student’s t test for continuous variables and the chi-square or Fisher’s exact test for categorical variables. Odds ratios (ORs) and risk ratios (RRs) with 95% confidence intervals (CIs) are reported where applicable. p values <0.05 were considered statistically significant.) Neoadjuvant Chemotherapy + Surgery (Group A) n=47 Neoadjuvant Chemoimmunotherapy+Surgery (Group B) n=29 p Value Odds Ratio/ Risk Ratio (95% CI) Age 62.7 ± 8.2 62.9 ± 6.3 0.233 0.89 (-3.78-3.31) Gender -Male -Female 42 (89.4%) 5 (10.6%) 26 (89.7%) 3 (10.3%) 0.968 0.97 (0.21-4.40) Table 2 Univariate and multivariate analyses of clinical, surgical, and pathological factors in patients undergoing surgery after neoadjuvant chemotherapy or neoadjuvant chemo-immunotherapy. (Univariate and multivariate analyses were performed to identify factors associated with surgical and pathological outcomes. Continuous variables were analyzed using linear regression, and categorical variables were analyzed using binary logistic regression. Results are presented as odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs), where applicable. Variables with a p value <0.20 in univariate analysis were included in multivariate models. A p value <0.05 was considered statistically significant.) Characteristics Neoadjuvant Chemotherapy + Surgery (Group A) n=47 Neoadjuvant Chemo immunotherapy+ Surgery (Group B) n=29 Univariate Analysis Multivariate Analysis p Value OR / RR (95% CI) p Value OR / RR (95% CI) Cigarette (packxyear) 59 ± 37 45 ± 26 0.016 0.1 (-2.2-29.1) 0.136 0.3 (-0.1-0.9) FVC (liter) 3.14 ± 0.75 3.06 ± 0.72 0.830 0.6 (-0.3-0.5) - - FEV1 (liter) 2.36 ± 0.55 2.37 ± 0.65 0.180 1.0 (-0.3-0.3) 0.793 0.1 (-0.4-0.6) FVC (%) 84.4 ± 13.6 82.3 ± 17.0 0.080 0.6 (-5.4-9.7) 0.724 0.4 (-0.1-0.3) FEV1 (%) 80.1 ± 12.2 79.9 ± 19.9 <0.001 1.0 (-7.3-7.6) 0.286 1.1 (-0.1-0.1) FEV1/FVC (%) 75.8 ± 9.4 74.7 ± 8.2 0.855 0.6 (-0.1-0.1) - - Albumin 43.9 ± 2.9 44.4 ± 2.8 0.983 0.4 (-1.9-0.8) - - C-reactive protein 12.8 ± 18.4 7.5 ± 10.1 0.083 0.2 (-2.4-13.0) 0.471 0.2 (-0.1-0.1) Lactate Dehydrogenase 258.4 ± 96.4 288.0 ± 146.3 0.139 0.4 (-106.0-46.9) 0.281 0.2 (-0.1-0.1) Leukocyte 7.9 ± 2.7 7.4 ± 2.0 0.168 0.3 (-0.6-1.7) 0.822 0.1 (-0.1-0.1) Lymphocyte 2.3 ± 0.9 2.1 ± 0.7 0.322 0.4 (-0.2-0.6) - - Neutrophil 5.7 ± 6.0 4.3 ± 1.5 0.130 0.2 (-0.9-3.7) 0.132 0.3 (-0.1-0.1) Hemoglobin 12.3 ± 1.7 12.5 ± 1.1 0.010 0.5 (-1.0-0.5) 0.404 0.2 (-0.1-0.1) Preoperative Tumor SUVmax 14.8 ± 6.9 16.1 ± 7.2 0.766 0.5 (-4.7-2.1) - - Preoperative Lymph Node SUVmax 5.5 ± 6.1 6.2 ± 5.2 0.435 0.7 (-3.5-2.3) - - Preoperative Radiological Tumor Diameter 3.8 ± 2.6 2.1 ± 1.9 0.398 0.1 (0.6-2.8) - - Operation Time (minute) 244 ± 48 210 ± 29 0.005 0.1 (12.8-52.1) 0.016 0.5 (0.1-0.9) Postoperative Hospital Stay 6.4 ± 5.0 5.5 ± 3.0 0.408 0.4 (-1.1-3.0) - - ASA Score -2 -3 14 (29.8%) 33 (70.2%) 8 (27.6%) 21 (72.4%) 0.839 1.1 (0.4-3.1) - - Smoking History -Ex-smoker -Active smoker -Non-Smoker 44 (93.6%) 1 (2.1%) 2 (4.3%) 29 (100%) 0 0 0.382 0.4 (0.1-0.7) - - Charlson Comorbidity Risk Index -3 -4 -5 -6 -7 -8 14 (29.8%) 10 (21.3%) 11 (23.4%) 9 (19.1%) 2 (4.3%) 1 (2.1%) 3 (10.3%) 11 (37.9%) 8 (27.6%) 2 (7.0%) 3 (10.3%) 2 (6.9%) 0.165 0.8 (0.1-23.2) 0.607 1.0 (0.1-34.2) cT Stage Before Neoadjuvant Treatment -T1 -T2 -T3 -T4 9 (19.1%) 10 (21.3%) 18 (38.3%) 10 (21.3%) 10 (34.5%) 7 (24.1%) 9 (31.0%) 3 (10.4%) 0.352 0.3 (0.1-0.8) - - cN Stage Before Neoadjuvant Treatment -N0 -N1 -N2 -N3 10 (21.3%) 3 (6.4%) 31 (65.9%) 3 (6.4%) 4 (13.%) 4 (13.8%) 21 (72.4%) 0 0.311 0.1 (0.1-0.5) - - cTNM Stage Before Neoadjuvant Treatment -Stage 1 -Stage 2 -Stage 3 -Stage 4 9 (19.2%) 29 (61.7%) 6 (12.8%) 3 (6.3%) 7 (24.1%) 20 (69.0%) 2 (6.9%) 0 0.424 0.4 (0.1-5.0) - - Radiological Assessment of Response to Treatment -Complete Response -Near Complete Response -Partial Regresyon 3 (6.4%) 8 (17.0%) 36 (76.6%) 5 (17.2%) 8 (27.6%) 16 (55.2%) 0.125 1.3 (0.1-32.4) 0.944 1.7 (0.1-45.7) cT Stage After Neoadjuvant Treatment -T0 -T1 -T2 -T3 -T4 5 (10.6%) 17 (36.2%) 19 (40.4%) 3 (6.4%) 3 (6.4%) 5 (17.2%) 15 (51.7%) 7 (24.1%) 1 (3.5%) 1 (3.5%) 0.528 0.6 (0.2-7.3) - - cN Stage After Neoadjuvant Treatment -N0 -N1 -N2 33 (70.2%) 8 (17.0%) 6 (12.8%) 21 (72.4%) 3 (10.4%) 5 (17.2%) 0.666 0.4 (0.1-6.4) - - cTNM Stage After Neoadjuvant Treatment -Stage 0 (T0N0M0) -Stage 1A2 -Stage 1A3 -Stage 1B -Stage 2A -Stage 2B -Stage 3A -Stage 3B 5 (10.6%) 5 (10.6%) 8 (17.0%) 6 (12.8%) 7 (14.9%) 11 (23.4%) 3 (6.4%) 2 (4.3%) 5 (17.2%) 2 (6.9%) 9 (31.0%) 5 (17.2%) 1 (3.6%) 5 (17.2%) 2 (6.9%) 0 0.467 1.0 (0.3-4.5) - - Incision -VATS -Thoracotomy 23 (48.9%) 24 (51.1%) 22 (75.9%) 7 (24.1%) 0.02 0.3 (0.1-0.9) 0.027 13.7 (1.4-16.9) Conversion from VATS to Thoracotomy 3 (6.4%) 2 (6.9%) 0.584 0.6 (0.1-3.4) - - Resection Type -Lobectomy -Bilobectomy -Pneumonectomy 29 (61.7%) 1 (2.1%) 17 (36.2%) 20 (69.0%) 1 (3.4%) 8 (27.6%) 0.716 5.4 (2.1-33.4) - - Pathology -Adenocarcinoma -Squamous Cell Carcinoma 20 (42.6%%) 27 (57.4%) 10 (59.6%) 19 (40.4%) 0.422 0.4 (0.1-0.5) - - Surgical Margin -Negative -Positive 43 (91.5%) 4 (8.5%) 28 (96.6%) 1 (3.4%) 0.387 0.4 (0.1-3.6) - - pT Stage -T0 -T1 -T2 -T3 -T4 7 (14.9%) 11 (23.4%) 13 (27.7%) 8 (17.0%) 8 (17.0%) 15 (51.7%) 2 (6.9%) 8 (27.6%) 4 (13.8%) 0 0.019 0.3 (0.1-0.8) 0.996 0.2 (-0.1-0.1) pN Stage -N0 -N1 -N2 28 (59.6%) 10 (21.3%) 9 (19.1%) 24 (82.8%) 1 (3.4%) 4 (13.8%) 0.102 0.2 (0.1-0.3) 0.774 0.2 (-0.1-0.1) Pathological TNM Stage -Stage 0 (T0N0M0) -Stage 1A2 -Stage 1A3 -Stage 1B -Stage 2A -Stage 2B -Stage 3A -Stage 3B 8 (17.0%) 6 (12.8%) 4 (8.5%) 5 (10.6%) 1 (2.1%) 9 (19.2%) 12 (25.5%) 2 (4.3%) 15 (51.7%) 1 (3,5%) 1 (3,5%) 4 (13.8%) 0 4 (13.8%) 3 (10.3%) 1 (3,4%) 0.054 0.6 (0.1-0.8) 0.116 0.4 (-0.1-0.1) Pathological Complete Response -Yes -No 8 (17.0%) 39 (83.0%) 15 (51.7%) 14 (48.3%) 0.001 5.2 (1.8-15.0) 0.034 4.5 (0.1-17.0) Perineural Invasion 11 (23.4%) 5 (17.2%) 0.522 0.7 (0.2-2.2) - - Lymphatic Invasion 20 (42.6%) 7 (24.1%) 0.103 0.4 (0.2-1.2) 0.114 0.1 (0.1-2.8) Vascular Invasion 17 (36.2%) 2 (6.9%) 0.004 0.1 (0.1-0.6) 0.124 23.5 (0.2-36.4) Pleural Invasion 0 1 38 (80.9%) 9 (19.1%) 24 (82.8%) 5 (17.2%) 0.835 0.9 (0.3-3.0) - - Postoperative Complication -Atrial Fibrillation -Prolonged Air Leak -Wound Infection -Pneumonia 9 (19.2%) 4 (8.5%) 4 (8.5%) 1 (2.2%) 0 9 (31.0%) 3 (10.4%) 3 (10.3%) 0 3 (10.3%) 0.236 1.9 (0.7-5.5) - - 30-Day Mortality 0 3 (10.3%) 0.024 1.1 (1.0-1.3) 0.998 0.1 (-0.2-0.3) 90-Day Mortality 0 3 (10.3%) 0.024 1.1 (1.0-1.3) 0.998 0.1 (-0.2-0.3) Table 3 Survival outcomes of patients undergoing surgery after neoadjuvant chemotherapy or neoadjuvant chemo-immunotherapy. (Survival data are presented as mean survival time (months) with corresponding measures of variability, where applicable. Survival was estimated using the Kaplan–Meier method and compared between groups using the log-rank test. A p value <0.05 was considered statistically significant.) 1-Year Survival Rate (%) Mean Survival (Months) 95% Confidence Interval p Value Neoadjuvant Chemotherapy n=47 89.4% 19.8 ± 0.9 18.1-21.6 0.353 Neoadjuvant Chemoimmunotherapy n=29 82.8% 17.4 ± 1.4 14.6-20.2 Table 4 DFS events included local recurrence, locoregional recurrence, distant metastasis, or death from any cause. (Mean DFS was estimated using the Kaplan–Meier method, and comparisons between groups were performed using the log-rank test.) 1-Year DFS Rate (%) Mean DFS (Months) 95% Confidence Interval p Value Neoadjuvant Chemotherapy n=47 74.5% 16.4 ± 1.2 14.0-18.7 0.249 Neoadjuvant Chemoimmunotherapy n=29 86.2% 18.4 ± 1.1 16.2-20.6 Additional Declarations No competing interests reported. Supplementary Files floatimage1.png Graphical Abstract Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 27 Apr, 2026 Reviews received at journal 06 Apr, 2026 Reviews received at journal 01 Apr, 2026 Reviews received at journal 22 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviews received at journal 16 Mar, 2026 Reviewers agreed at journal 13 Mar, 2026 Reviewers agreed at journal 12 Mar, 2026 Reviewers agreed at journal 12 Mar, 2026 Reviews received at journal 11 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers invited by journal 04 Feb, 2026 Editor assigned by journal 22 Jan, 2026 Submission checks completed at journal 21 Jan, 2026 First submitted to journal 20 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8588919","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":585662074,"identity":"991d4e15-8a94-4143-a4ce-d763c71d45bc","order_by":0,"name":"Gizem Özçıbık Işık","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIie2QvwrCMBCHLwTiUu3cyVeIiyCofZVKoVOFjo4FoS5R1zr5EIK7BPsMyk0iOFcEEelg6p/RVjfBfHCXO/h9wwVAo/lRJHAHWD6lqljlG4XEuUI/UFTGeQzGcy3ENOVOBoHXnZhyvWhfl/UaBZIe/feKFSZcxtx3I0g87E+wEVGg1mz5XuErAdLgA5cR0cS+QKIURqtFijSeCjXP2BJolyvJXfG7jBkM4YK9UsUSLL/Fc5TR3I5DdCNKhoW3qB/bn4LMtetTedhcMuzMR8NVeixQXvTCvJPo3sPyvMJ+PNlHYY1Go/kzbvWITgM3GG1OAAAAAElFTkSuQmCC","orcid":"","institution":"Yedikule Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Gizem","middleName":"Özçıbık","lastName":"Işık","suffix":""},{"id":585662075,"identity":"9bfc503d-f492-4b1b-a3fb-a6facb87ce9a","order_by":1,"name":"Ezgi Nilay Yağcı Kazanasmaz","email":"","orcid":"","institution":"Yedikule Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ezgi","middleName":"Nilay Yağcı","lastName":"Kazanasmaz","suffix":""},{"id":585662076,"identity":"9a3e9e22-85eb-46d2-9add-37bc3a3739ab","order_by":2,"name":"Umut Kilimci","email":"","orcid":"","institution":"Yedikule Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Umut","middleName":"","lastName":"Kilimci","suffix":""},{"id":585662077,"identity":"2a56af6b-6c7c-4678-950a-dcce137a2ae1","order_by":3,"name":"Mustafa Vedat Doğru","email":"","orcid":"","institution":"Yedikule Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mustafa","middleName":"Vedat","lastName":"Doğru","suffix":""},{"id":585662079,"identity":"5aac17bc-e926-4bb8-8dec-103e5724c6d7","order_by":4,"name":"Celal Buğra Sezen","email":"","orcid":"","institution":"Yedikule Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Celal","middleName":"Buğra","lastName":"Sezen","suffix":""},{"id":585662080,"identity":"6ae6e4cd-fce0-47df-921c-9a7c4dbdf575","order_by":5,"name":"Levent Cansever","email":"","orcid":"","institution":"Yedikule Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Levent","middleName":"","lastName":"Cansever","suffix":""},{"id":585662081,"identity":"572e936a-0ea9-46d8-b95b-067f6192d51c","order_by":6,"name":"Özkan Saydam","email":"","orcid":"","institution":"Yedikule Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Özkan","middleName":"","lastName":"Saydam","suffix":""}],"badges":[],"createdAt":"2026-01-13 07:54:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8588919/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8588919/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102211648,"identity":"afb8f14b-4abe-4140-8b8c-7b8edb67f1f0","added_by":"auto","created_at":"2026-02-09 12:28:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70060,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier overall survival curves of patients undergoing surgery after neoadjuvant chemotherapy or neoadjuvant chemo-immunotherapy.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8588919/v1/5f705b0dd44394b6ae844439.png"},{"id":102211758,"identity":"a6d94fff-20d0-492a-86ab-2af55983e14d","added_by":"auto","created_at":"2026-02-09 12:28:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":70968,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier disease-free survival curves of patients undergoing surgery after neoadjuvant chemotherapy or neoadjuvant chemo-immunotherapy.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8588919/v1/e81339132932d4a6fc493a25.png"},{"id":102211783,"identity":"f9e638e4-3c08-4d11-a797-2c476d20c6f2","added_by":"auto","created_at":"2026-02-09 12:28:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2010167,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8588919/v1/8ddba39c-a4e2-4c5a-b77e-86992f107f17.pdf"},{"id":102211721,"identity":"95462d78-7f86-4ced-a93c-6db4a49049d3","added_by":"auto","created_at":"2026-02-09 12:28:14","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":63003,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraphical Abstract\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8588919/v1/22164a542602123f730ab429.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Feasibility and Early Outcomes of Surgery After Neoadjuvant Chemoimmunotherapy in Locally Advanced Non–Small Cell Lung Cancer","fulltext":[{"header":"Background","content":"\u003cp\u003eNon\u0026ndash;small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide and represents the most common lung cancer subtype.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The 9th TNM staging system is used for disease staging.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e According to this system, patients classified as stage IIB, IIIA, and IIIB are defined as having locally advanced disease, for whom treatment modalities vary and multidisciplinary evaluation is required.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe primary aims of neoadjuvant treatments administered before surgery are to achieve tumor regression, thereby allowing more limited lung resections (e.g., sleeve lobectomy or lobectomy instead of pneumonectomy), to eliminate invasion of major vessels and adjacent organs to improve resectability, to eradicate mediastinal lymph node involvement in patients with N2 disease, rendering them suitable for surgical intervention, and to eliminate occult systemic micrometastatic disease.\u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe literature demonstrates that surgery can be safely performed following neoadjuvant chemotherapy and radiotherapy, with favorable short- and long-term outcomes.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e In recent years, immunotherapy agents have also gained a role in the treatment of locally advanced NSCLC.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Immune checkpoint inhibitors (ICIs), including programmed cell death protein-1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors, activate the antitumor immune response of T cells by blocking PD-1/PD-L1 binding and preventing tumor immune escape.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Clinical trials such as CheckMate-816 (nivolumab), KEYNOTE-671 (pembrolizumab), and IMpower030 (atezolizumab) have shown that the addition of immunotherapy to neoadjuvant chemotherapy regimens (cisplatin plus pemetrexed or carboplatin plus paclitaxel) improves overall survival.\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Compared with chemotherapy and radiotherapy, immunotherapy agents have a more favorable adverse event profile and provide a more durable antitumor effect.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNeoadjuvant chemotherapy has been reported to increase postoperative complication rates, 30-day mortality, and readmission rates, and it requires caution during surgery due to treatment-related tissue changes.\u003csup\u003e\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Similarly, neoadjuvant chemo-immunotherapy may lead to tissue alterations and changes in pulmonary function, presenting various surgical challenges; nevertheless, the feasibility of surgery following neoadjuvant chemo-immunotherapy has been demonstrated.\u003csup\u003e\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFor these reasons, the present study aimed to compare patients with locally advanced NSCLC who received neoadjuvant chemotherapy or neoadjuvant chemo-immunotherapy and subsequently underwent anatomical lung resection with systematic lymph node dissection, and to evaluate the early surgical outcomes following neoadjuvant chemo-immunotherapy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e Ethical committee approval for this study was obtained from our institution (Non-Interventional Clinical Research Ethics Committee of Istanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital; Date:25.12.2025; Number:2025-1). Patients who underwent surgery for non\u0026ndash;small cell lung cancer at our clinic between January 2024 and September 2025 were included in the study. The inclusion criteria were a diagnosis of locally advanced disease (stage IIB, IIIA, or IIIB) according to the 9th TNM staging system at initial presentation and undergoing surgical resection following neoadjuvant treatment. Patients who received radiotherapy and demonstrated disease progression were excluded. Patient data were evaluated retrospectively.\u003c/p\u003e \u003cp\u003eA total of 76 patients met the inclusion criteria; 47 patients received neoadjuvant chemotherapy (61.8%), and 29 patients received neoadjuvant chemo-immunotherapy (38.2%). The clinical, surgical, and pathological characteristics of patients who underwent neoadjuvant chemotherapy followed by surgery (Group A) and neoadjuvant chemo-immunotherapy followed by surgery (Group B) were compared.\u003c/p\u003e \u003cp\u003eIn our routine clinical practice, patients initially diagnosed with locally advanced disease undergo clinical staging, pathological confirmation, and invasive mediastinal staging (endobronchial ultrasound [EBUS], endoscopic ultrasonography (EUS), videomediastinoscopy, video-assisted mediastinoscopic lymphadenectomy [VAMLA] or mediastinotomy), followed by evaluation in a multidisciplinary lung cancer board to determine eligibility for neoadjuvant treatment. In our study, in accordance with the CheckMate-816 trial criteria, immunotherapy was planned for patients who were EGFR- and ALK-negative and had a PD-L1 expression level greater than 1%. In our healthcare system, immunotherapy is administered to patients with adenocarcinoma histology when PD-L1 expression is greater than 1%, whereas in patients with squamous cell carcinoma histology, immunotherapy is administered regardless of PD-L1 status. Accordingly, PD-L1 expression levels were not available for all patients. All patients in the chemo-immunotherapy group received nivolumab as the immunotherapy agent. After completion of the neoadjuvant treatment protocol, patients are re-evaluated clinically and radiologically by the multidisciplinary board. Patients without radiological or metabolic disease progression, or those demonstrating regression, and deemed resectable undergo re-mediastinal staging, after which surgical resection is planned. Surgery is typically scheduled approximately 4\u0026ndash;6 weeks after the final dose of neoadjuvant treatment.\u003c/p\u003e \u003cp\u003eStatistical analyses were performed using SPSS software (version 27.00; IBM Corp., Armonk, NY, USA). Descriptive statistics were summarized as numbers and percentages for categorical variables and as mean, standard deviation, minimum, and maximum values for parametric variables. Associations between categorical variables were assessed using the chi-square (χ\u0026sup2;) test or Fisher\u0026rsquo;s exact test, as appropriate. Continuous variables were analyzed using Student\u0026rsquo;s t-test or the Mann\u0026ndash;Whitney U test. In multivariate analyses, parametric variables were evaluated using linear regression, whereas categorical variables were analyzed using binary logistic regression. Survival analysis was performed using the Kaplan\u0026ndash;Meier method, with comparisons conducted using the log-rank test. Disease-free survival (DFS) was defined as the time from surgery to the first documented occurrence of local recurrence, locoregional recurrence, distant metastasis, or death from any cause. Multivariate survival analysis was carried out using Cox proportional hazards regression. A p value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOur study included 76 patients; 47 patients received neoadjuvant chemotherapy (61.8%), and 29 patients received neoadjuvant chemo-immunotherapy (38.2%). Among patients receiving neoadjuvant chemotherapy, 42 (89.4%) were male, while 26 patients (89.7%) in the neoadjuvant chemo-immunotherapy group were male. The mean age was 62.7 ± 8.2 years in Group A and 62.9 ± 6.3 years in Group B. There were no statistically significant differences in demographic characteristics between the groups (p=0.968 and p=0.233, respectively; Table 1).\u003c/p\u003e\n\u003cp\u003eIn univariate analysis, smoking pack-years and FEV1 percentage were significantly lower in Group B, whereas hemoglobin levels were significantly higher (p=0.016, p\u0026lt;0.001, and p=0.010, respectively; Table 2).\u003c/p\u003e\n\u003cp\u003eOperation duration was significantly longer in Group A (p=0.005). Minimally invasive surgery using video-assisted thoracoscopic surgery (VATS) was performed significantly more frequently in Group B, while no statistically significant difference was observed in conversion rates to open surgery between the groups (p=0.02 and p=0.584, respectively; Table 2).\u003c/p\u003e\n\u003cp\u003eThe groups had similar TNM characteristics regarding staging before neoadjuvant treatment and prior to surgical intervention (Table 2). Postoperative pathological T stage was significantly earlier in Group B, and the pathological complete response rate was significantly higher in this group (p=0.019 and p=0.001, respectively). The incidence of vascular invasion was significantly higher in Group A (p=0.004). Although postoperative complication rates were comparable between the groups, 30- and 90-day mortality rates were higher in Group B in univariate analysis (p=0.236 and p=0.024, respectively). The most common postoperative complications were atrial fibrillation, prolonged air leak, pneumonia, and wound infection. The cause of 30-day mortality was pneumonia followed by acute respiratory failure (Table 2).\u003c/p\u003e\n\u003cp\u003eIn multivariate analysis, operation time was significantly shorter in Group B (p=0.016; RR: 0.5; 95% CI: 0.1–0.9). Minimally invasive surgery using a VATS approach was performed 13.7 times more frequently in Group B (p=0.027; 95% CI: 1.4–16.9). Pathological complete response was 4.5 times more frequent in Group B (p=0.034; 95% CI: 0.1–17.0).\u003c/p\u003e\n\u003cp\u003eThe mean follow-up duration was 22.3 ± 1.2 months. Mean survival was 19.8 ± 0.9 months in Group A and 17.4 ± 1.4 months in Group B, with no statistically significant difference between the groups (p=0.353; Table 3 and Figure 1). In multivariate survival analysis, pathological T stage, vascular invasion, and pathological complete response were not statistically significant predictors of survival (p=0.985, p=0.265, and p=0.951, respectively).\u003c/p\u003e\n\u003cp\u003eDisease-free survival (DFS) analysis demonstrated a numerically higher DFS in the neoadjuvant chemo-immunotherapy group compared with the neoadjuvant chemotherapy group. The 1-year DFS rate was 74.5% in patients who received neoadjuvant chemotherapy and 86.2% in those who received neoadjuvant chemo-immunotherapy. Mean DFS was 16.4 months (95% CI: 14.0–18.7) in the neoadjuvant chemotherapy group and 18.4 months (95% CI: 16.2–20.6) in the neoadjuvant chemo-immunotherapy group. However, the difference in DFS between the two groups did not reach statistical significance (p = 0.249) (Table 4, Figure 2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study demonstrates that surgery following neoadjuvant chemo-immunotherapy is technically feasible, is associated with higher rates of minimally invasive surgery, and results in significantly increased pathological complete response rates.\u003c/p\u003e \u003cp\u003eOne of the primary goals of neoadjuvant therapy is to increase resectability by achieving tumor regression and to allow for more limited lung resections.\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Recent studies have shown that neoadjuvant protocols, particularly those incorporating immune checkpoint inhibitors (ICIs), significantly improve pathological response rates.\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e In the CheckMate-816 trial, the pathological complete response rate was reported as 24% in the neoadjuvant nivolumab plus chemotherapy arm, compared with 2.2% in the chemotherapy-only arm [5]. The significantly higher pathological complete response rate observed in the chemo-immunotherapy group in our study is consistent with the existing literature and further supports the efficacy of neoadjuvant immunotherapy.\u003c/p\u003e \u003cp\u003eFurthermore, the higher rate of video-assisted thoracoscopic surgery (VATS) in the chemo-immunotherapy group and the absence of a difference in conversion rates to open surgery suggest that immunotherapy does not render surgical dissection technically prohibitive. In a previous study conducted at our institution, the conversion rate from minimally invasive surgery to open surgery was 4.7%, whereas this rate was observed to be higher in patients who received neoadjuvant chemotherapy or chemo-immunotherapy [18]. Ostrovetsky et al. reported increased surgical difficulty due to fibrosis and hilar\u0026ndash;mediastinal adhesions following immunotherapy.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Similarly, Mitsudomi et al. highlighted these technical challenges but demonstrated that minimally invasive surgery can be safely performed after neoadjuvant chemo-immunotherapy in experienced centers.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e In our clinic, the accumulated experience of our surgical team with minimally invasive approaches following neoadjuvant chemotherapy and the completion of the learning curve may have contributed to the more frequent use of minimally invasive techniques after chemo-immunotherapy. Additionally, increased experience with hilar and mediastinal dissection in patients undergoing surgery after neoadjuvant chemotherapy may explain the comparable conversion rates from VATS to thoracotomy between the groups. For these reasons, we believe that surgical procedures following neoadjuvant chemo-immunotherapy can be performed safely and minimally invasively by experienced surgical teams.\u003c/p\u003e \u003cp\u003eThe longer operation time observed in the neoadjuvant chemotherapy group may be related to more advanced fibrotic changes, a higher incidence of vascular invasion, and increased rates of open surgery in this group. In contrast, the significantly shorter operation time in the chemo-immunotherapy group in multivariate analysis may be explained by better tumor regression and earlier pathological T stage. These findings suggest that neoadjuvant chemo-immunotherapy is at least as favorable as chemotherapy from a surgical perspective and may even be advantageous in selected cases.\u003c/p\u003e \u003cp\u003eIn our study, the earlier pathological T stage and lower frequency of vascular invasion observed in the chemo-immunotherapy group support the favorable effect of immunotherapy on tumor biology.\u003csup\u003e5\u0026ndash;7,12\u0026minus;14\u003c/sup\u003e Although previous studies have demonstrated an association between pathological complete response and long-term survival, we were unable to observe a survival benefit in our cohort, likely due to the relatively short follow-up period.\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e With the completion of longer-term follow-up, the positive impact of pathological complete response on survival may become more apparent.\u003c/p\u003e \u003cp\u003eWhile postoperative complication rates were similar between the two groups, it is noteworthy that 30- and 90-day mortality rates were higher in the chemo-immunotherapy group in univariate analysis but did not remain statistically significant in multivariate analysis. This finding may be related to subclinical pulmonary toxicity associated with immunotherapy, the risk of immune-related pneumonitis, and a lower preoperative respiratory reserve, as reflected by the significantly reduced preoperative pulmonary function parameters\u0026mdash;particularly FEV1 percentages\u0026mdash;observed in the chemo-immunotherapy group. In addition, baseline laboratory findings in this group, including lower hemoglobin levels and altered inflammatory markers, may indicate a more fragile physiological status, potentially predisposing these patients to adverse early postoperative outcomes. Although increased early mortality following neoadjuvant immunotherapy has not been clearly demonstrated in the literature, these results underscore the importance of careful patient selection, particularly with respect to pulmonary function, baseline physiological reserve, and the risk of immune-related adverse effects.\u003csup\u003e\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e The loss of statistical significance in multivariate analysis further suggests that the observed mortality difference may primarily reflect selection bias related to the retrospective study design and baseline differences in respiratory reserve and laboratory parameters rather than a direct effect of chemo-immunotherapy itself.\u003c/p\u003e \u003cp\u003eNo significant difference in median survival was observed between the groups. However, the relatively short mean follow-up period may have limited our ability to assess the long-term survival benefit of neoadjuvant chemo-immunotherapy. This finding may also be influenced by the limited sample size and heterogeneous stage distribution. Additionally, the lack of significance for pathological T stage, vascular invasion, and pathological complete response in the multivariate survival analysis further suggests that the study may be underpowered. Larger studies with longer follow-up durations are required to more clearly define the survival impact of neoadjuvant chemo-immunotherapy.\u003c/p\u003e \u003cp\u003eIn terms of disease-free survival, the neoadjuvant chemo-immunotherapy group demonstrated numerically higher DFS rates compared with the neoadjuvant chemotherapy group. Although both the 1-year DFS rate and median DFS favored the chemo-immunotherapy group, this difference did not reach statistical significance. This finding may be attributed to the relatively short follow-up period, limited sample size, and heterogeneous stage distribution of the study population. Given that DFS is often an earlier and more sensitive endpoint for treatment efficacy than overall survival, longer follow-up may reveal a more pronounced separation between the survival curves, particularly in favor of neoadjuvant chemo-immunotherapy.\u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e The main limitations of our study include its retrospective design, single-center setting, potential selection bias in surgical decision-making, relatively small sample size, and limited follow-up period. Moreover, the heterogeneity of immunotherapy regimens, the absence of PD-L1 expression and molecular mutation data in all patients, and the inability to assess the impact of these biomarkers on pathological response and clinical outcomes limit the generalizability of our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, surgery following neoadjuvant chemo-immunotherapy is a safe and feasible approach in patients with locally advanced NSCLC. Notably, the addition of immunotherapy to neoadjuvant chemotherapy resulted in a significantly higher pathological complete response rate and earlier pathological T stage, highlighting the oncologic advantage of chemo-immunotherapy in terms of tumor regression and pathological downstaging. Although early postoperative mortality warrants careful patient selection and close postoperative follow-up, neoadjuvant chemo-immunotherapy appears to provide meaningful pathological benefit without compromising surgical feasibility. Prospective, randomized studies with longer follow-up and biomarker-driven stratification are needed to clarify its impact on long-term survival outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e Ethical committee approval was obtained for the study (Non-Interventional Clinical Research Ethics Committee of Istanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital; Date:25.12.2025; Number:2025-1). Participation was voluntary, and informed consent was obtained from all respondents. This study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClinical trial number\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConflicts of interest/Competing interests:\u003c/h2\u003e \u003cp\u003eAuthors have no conflicts of interest or financial ties to disclose.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo source of funding or research and/or publication. Authors declare they have nothing to disclose.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eG\u0026Ouml;I, ENYK, UK, MVD, CBS, LC, and \u0026Ouml;S designed the study, acquired and analyzed data and approved its final version.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data in the study are available for consultation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJiang P, Chen W, Zheng G, Li X, Song X. Non-small cell lung cancer subtype classification based on cross-scale multi-instance learning. Sci Rep. 2025;15(1):43210.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRami-Porta R, Nishimura KK, Giroux DJ, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groups in the Forthcoming (Ninth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2024;19(7):1007\u0026ndash;1027.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesai PA, Borghaei H, Edelman MJ. Neoadjuvant Chemo-Immunotherapy for Surgically Resectable Non-Small Cell Lung Cancer: Balancing Promise and Pitfalls. Clin Lung Cancer. 2025;27(1):55\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374(9687):379\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForde PM, Spicer J, Lu S, et al. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med. 2022;386(21):1973\u0026ndash;1985.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpicer JD, Garassino MC, Wakelee H, et al. 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. Lancet. 2024;404(10459):1240\u0026ndash;1252.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRusch VW, Nicholas A, Patterson GA, et al. Surgical results of the Lung Cancer Mutation Consortium 3 trial: A phase II multicenter single-arm study to investigate the efficacy and safety of atezolizumab as neoadjuvant therapy in patients with stages IB-select IIIB resectable non-small cell lung cancer. J Thorac Cardiovasc Surg. 2023;165(3):828\u0026ndash;839.e5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu W, Tang J, Li X, et al. Reduction in surgical scope after neoadjuvant chemotherapy and immunotherapy for non-small cell lung cancer. Oncol Lett. 2025;30(5):501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWerner RS, Steinmann N, Opitz I. Update on Neoadjuvant and Adjuvant Trials. Thorac Surg Clin. 2026;36(1):91\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi M, Yin H, Jin Y, et al. A Real-World Study of Resectable NSCLC Following Neoadjuvant Immunotherapy: Should Postoperative Adjuvant Immunotherapy be Recommended? Thorac Cancer. 2025;16(23):e70195.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpigel DR, Faivre-Finn C, Gray JE, et al. Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. J Clin Oncol. 2022;40(12):1301\u0026ndash;1311.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa J, Jiang J. Exploration of immunotherapy modalities in stage III unresectable non-small cell lung cancer (Review). Oncol Lett. 2025;31(2):46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Brien M, Paz-Ares L, Marreaud S, et al. Pembrolizumab versus placebo as adjuvant therapy for completely resected stage IB-IIIA non-small-cell lung cancer (PEARLS/KEYNOTE-091): an interim analysis of a randomised, triple-blind, phase 3 trial. Lancet Oncol. 2022;23(10):1274\u0026ndash;1286.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagee DE, Hird AE, Klaassen Z, et al. Adverse event profile for immunotherapy agents compared with chemotherapy in solid organ tumors: a systematic review and meta-analysis of randomized clinical trials. Ann Oncol. 2020;31(1):50\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKneuertz PJ, Villamizar N, Altorki NK, et al. Minimally invasive resection of non-small cell lung cancer after chemoimmunotherapy: A multicenter study in academic hospitals. J Thorac Cardiovasc Surg. 2025;170(6):1803\u0026ndash;1812.e2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCerfolio RJ, Talati A, Bryant AS. Changes in pulmonary function tests after neoadjuvant therapy predict postoperative complications. Ann Thorac Surg. 2009;88(3):930\u0026ndash;5; discussion 935-6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrisciandaro E, Bertolaccini L, Passani S, Szanto Z. Predictors of 30-day Morbidity and Unplanned Readmission After Induction Therapy Followed by Lung Resection for Non-small Cell Lung Cancer: European Society of Thoracic Surgeons Database Analysis. Eur J Cardiothorac Surg. 2025 Dec 1;67(12):ezaf426.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSezen CB, Bilen S, Kalafat CE, et al. Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis. Gen Thorac Cardiovasc Surg. 2019;67(11):969\u0026ndash;975.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOstrovetsky O, Chudgar NP. Surgical Challenges After Neoadjuvant Therapy. Thorac Surg Clin. 2026;36(1):41\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Feng Y, Dai S, et al. Neoadjuvant Chemoimmunotherapy in Non-small-cell Lung Cancer Patients: Effects on Pulmonary Function and Incidence of Postoperative Pulmonary Complications-A Multicentre Real-World Study. Eur J Cardiothorac Surg. 2025;67(11):ezaf351.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitsudomi T, Heymach JV, Reck M, et al. Surgical Outcomes With Neoadjuvant Durvalumab Plus Chemotherapy Followed by Adjuvant Durvalumab in Resectable NSCLC. J Thorac Oncol. 2025;20(11):1639\u0026ndash;1654.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Baseline demographic characteristics of patients undergoing anatomical lung resection after neoadjuvant chemotherapy or chemo-immunotherapy for locally advanced non\u0026ndash;small cell lung cancer.\u003c/p\u003e\n\u003cp\u003e(Data are presented as mean \u0026plusmn; standard deviation or number (%), as appropriate. Comparisons between groups were performed using Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e test for continuous variables and the chi-square or Fisher\u0026rsquo;s exact test for categorical variables. Odds ratios (ORs) and risk ratios (RRs) with 95% confidence intervals (CIs) are reported where applicable. \u003cem\u003ep\u003c/em\u003e values \u0026lt;0.05 were considered statistically significant.)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeoadjuvant Chemotherapy +\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Group A)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=47\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeoadjuvant Chemoimmunotherapy+Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Group B)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds Ratio/ Risk Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e62.7 \u0026plusmn; 8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e62.9 \u0026plusmn; 6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003cp\u003e(-3.78-3.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Male\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Female\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42 (89.4%)\u003c/p\u003e\n \u003cp\u003e5 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26 (89.7%)\u003c/p\u003e\n \u003cp\u003e3 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003cp\u003e(0.21-4.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Univariate and multivariate analyses of clinical, surgical, and pathological factors in patients undergoing surgery after neoadjuvant chemotherapy or neoadjuvant chemo-immunotherapy.\u003c/p\u003e\n\u003cp\u003e(Univariate and multivariate analyses were performed to identify factors associated with surgical and pathological outcomes. Continuous variables were analyzed using linear regression, and categorical variables were analyzed using binary logistic regression. Results are presented as odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs), where applicable. Variables with a \u003cem\u003ep\u003c/em\u003e value \u0026lt;0.20 in univariate analysis were included in multivariate models. A \u003cem\u003ep\u003c/em\u003e value \u0026lt;0.05 was considered statistically significant.)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeoadjuvant Chemotherapy +\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Group A)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=47\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeoadjuvant Chemo immunotherapy+ Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Group B)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate Analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate Analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR / RR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR / RR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCigarette (packxyear)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e59 \u0026plusmn; 37\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e45 \u0026plusmn; 26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(-2.2-29.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003cp\u003e(-0.1-0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFVC (liter)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3.14 \u0026plusmn; 0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e3.06 \u0026plusmn; 0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e(-0.3-0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFEV1 (liter)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e2.36 \u0026plusmn; 0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.37 \u0026plusmn; 0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003cp\u003e(-0.3-0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e(-0.4-0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFVC (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e84.4 \u0026plusmn; 13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e82.3 \u0026plusmn; 17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e(-5.4-9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(-0.1-0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFEV1 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e80.1 \u0026plusmn; 12.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e79.9 \u0026plusmn; 19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(-7.3-7.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFEV1/FVC (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e75.8 \u0026plusmn; 9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e74.7 \u0026plusmn; 8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlbumin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e43.9 \u0026plusmn; 2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e44.4 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(-1.9-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC-reactive protein\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e12.8 \u0026plusmn; 18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e7.5 \u0026plusmn; 10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e(-2.4-13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLactate Dehydrogenase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e258.4 \u0026plusmn; 96.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e288.0 \u0026plusmn; 146.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(-106.0-46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeukocyte\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e7.9 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e7.4 \u0026plusmn; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003cp\u003e(-0.6-1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLymphocyte\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e2.3 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.1 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(-0.2-0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeutrophil\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5.7 \u0026plusmn; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e4.3 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e(-0.9-3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoglobin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e12.3 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.5 \u0026plusmn; 1.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.5\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(-1.0-0.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative Tumor SUVmax\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e14.8 \u0026plusmn; 6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e16.1 \u0026plusmn; 7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003e(-4.7-2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative Lymph Node SUVmax\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5.5 \u0026plusmn; 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e6.2 \u0026plusmn; 5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003cp\u003e(-3.5-2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative Radiological Tumor Diameter\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3.8 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.1 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e(0.6-2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperation Time (minute)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e244 \u0026plusmn; 48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e210 \u0026plusmn; 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(12.8-52.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.5\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.1-0.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative Hospital Stay\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e6.4 \u0026plusmn; 5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e5.5 \u0026plusmn; 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(-1.1-3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA Score\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (29.8%)\u003c/p\u003e\n \u003cp\u003e33 (70.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003cp\u003e21 (72.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003cp\u003e(0.4-3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking History\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Ex-smoker\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Active smoker\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Non-Smoker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 (93.6%)\u003c/p\u003e\n \u003cp\u003e1 (2.1%)\u003c/p\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (100%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(0.1-0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharlson Comorbidity Risk Index\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-5\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-6\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-7\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (29.8%)\u003c/p\u003e\n \u003cp\u003e10 (21.3%)\u003c/p\u003e\n \u003cp\u003e11 (23.4%)\u003c/p\u003e\n \u003cp\u003e9 (19.1%)\u003c/p\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003cp\u003e1 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (10.3%)\u003c/p\u003e\n \u003cp\u003e11 (37.9%)\u003c/p\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003cp\u003e2 (7.0%)\u003c/p\u003e\n \u003cp\u003e3 (10.3%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003cp\u003e(0.1-23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003cp\u003e(0.1-34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecT Stage Before Neoadjuvant Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (19.1%)\u003c/p\u003e\n \u003cp\u003e10 (21.3%)\u003c/p\u003e\n \u003cp\u003e18 (38.3%)\u003c/p\u003e\n \u003cp\u003e10 (21.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (34.5%)\u003c/p\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003cp\u003e3 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003cp\u003e(0.1-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecN Stage Before Neoadjuvant Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (21.3%)\u003c/p\u003e\n \u003cp\u003e3 (6.4%)\u003c/p\u003e\n \u003cp\u003e31 (65.9%)\u003c/p\u003e\n \u003cp\u003e3 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (13.%)\u003c/p\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003cp\u003e21 (72.4%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e(0.1-0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecTNM Stage Before Neoadjuvant Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (19.2%)\u003c/p\u003e\n \u003cp\u003e29 (61.7%)\u003c/p\u003e\n \u003cp\u003e6 (12.8%)\u003c/p\u003e\n \u003cp\u003e3 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003cp\u003e20 (69.0%)\u003c/p\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(0.1-5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiological \u0026nbsp;Assessment of Response to Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Complete Response\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Near Complete Response\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Partial Regresyon\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (6.4%)\u003c/p\u003e\n \u003cp\u003e8 (17.0%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36 (76.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (55.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003cp\u003e(0.1-32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003cp\u003e(0.1-45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecT Stage After Neoadjuvant Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (10.6%)\u003c/p\u003e\n \u003cp\u003e17 (36.2%)\u003c/p\u003e\n \u003cp\u003e19 (40.4%)\u003c/p\u003e\n \u003cp\u003e3 (6.4%)\u003c/p\u003e\n \u003cp\u003e3 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003cp\u003e15 (51.7%)\u003c/p\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003cp\u003e1 (3.5%)\u003c/p\u003e\n \u003cp\u003e1 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e(0.2-7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecN Stage After Neoadjuvant Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (70.2%)\u003c/p\u003e\n \u003cp\u003e8 (17.0%)\u003c/p\u003e\n \u003cp\u003e6 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (72.4%)\u003c/p\u003e\n \u003cp\u003e3 (10.4%)\u003c/p\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(0.1-6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecTNM Stage After Neoadjuvant Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 0 (T0N0M0)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 1A2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 1A3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 1B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 2A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 2B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 3A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 3B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (10.6%)\u003c/p\u003e\n \u003cp\u003e5 (10.6%)\u003c/p\u003e\n \u003cp\u003e8 (17.0%)\u003c/p\u003e\n \u003cp\u003e6 (12.8%)\u003c/p\u003e\n \u003cp\u003e7 (14.9%)\u003c/p\u003e\n \u003cp\u003e11 (23.4%)\u003c/p\u003e\n \u003cp\u003e3 (6.4%)\u003c/p\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003cp\u003e(0.3-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncision\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-VATS\u003cbr\u003e\u0026nbsp;-Thoracotomy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (48.9%)\u003c/p\u003e\n \u003cp\u003e24 (51.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e22 (75.9%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.1-0.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.027\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e13.7\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(1.4-16.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConversion from VATS to Thoracotomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e(0.1-3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResection Type\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Lobectomy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Bilobectomy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Pneumonectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (61.7%)\u003c/p\u003e\n \u003cp\u003e1 (2.1%)\u003c/p\u003e\n \u003cp\u003e17 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (69.0%)\u003c/p\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003cp\u003e(2.1-33.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathology\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Adenocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Squamous Cell Carcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (42.6%%)\u003c/p\u003e\n \u003cp\u003e27 (57.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (59.6%)\u003c/p\u003e\n \u003cp\u003e19 (40.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(0.1-0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical Margin\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Negative\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Positive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43 (91.5%)\u003c/p\u003e\n \u003cp\u003e4 (8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28 (96.6%)\u003c/p\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(0.1-3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003epT Stage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-T4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (14.9%)\u003c/p\u003e\n \u003cp\u003e11 (23.4%)\u003c/p\u003e\n \u003cp\u003e13 (27.7%)\u003c/p\u003e\n \u003cp\u003e8 (17.0%)\u003c/p\u003e\n \u003cp\u003e8 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e15 (51.7%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.1-0.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003epN Stage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-N2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28 (59.6%)\u003c/p\u003e\n \u003cp\u003e10 (21.3%)\u003c/p\u003e\n \u003cp\u003e9 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24 (82.8%)\u003c/p\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e(0.1-0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathological TNM Stage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 0 (T0N0M0)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 1A2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 1A3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 1B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 2A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 2B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 3A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Stage 3B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (17.0%)\u003c/p\u003e\n \u003cp\u003e6 (12.8%)\u003c/p\u003e\n \u003cp\u003e4 (8.5%)\u003c/p\u003e\n \u003cp\u003e5 (10.6%)\u003c/p\u003e\n \u003cp\u003e1 (2.1%)\u003c/p\u003e\n \u003cp\u003e9 (19.2%)\u003c/p\u003e\n \u003cp\u003e12 (25.5%)\u003c/p\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (51.7%)\u003c/p\u003e\n \u003cp\u003e1 (3,5%)\u003c/p\u003e\n \u003cp\u003e1 (3,5%)\u003c/p\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003cp\u003e3 (10.3%)\u003c/p\u003e\n \u003cp\u003e1 (3,4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e(0.1-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(-0.1-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathological Complete Response\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Yes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (17.0%)\u003c/p\u003e\n \u003cp\u003e39 (83.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e15 (51.7%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e14 (48.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e5.2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(1.8-15.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4.5\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.1-17.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerineural Invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11 (23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003cp\u003e(0.2-2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLymphatic Invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e20 (42.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(0.2-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e(0.1-2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVascular Invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17 (36.2%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(0.1-0.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003cp\u003e(0.2-36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePleural Invasion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38 (80.9%)\u003c/p\u003e\n \u003cp\u003e9 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24 (82.8%)\u003c/p\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003cp\u003e(0.3-3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative Complication\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Atrial Fibrillation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Prolonged Air Leak\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Wound Infection\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-Pneumonia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e9 (19.2%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (8.5%)\u003c/p\u003e\n \u003cp\u003e4 (8.5%)\u003c/p\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (10.4%)\u003c/p\u003e\n \u003cp\u003e3 (10.3%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e3 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003cp\u003e(0.7-5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30-Day Mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 (10.3%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(1.0-1.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e(-0.2-0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e90-Day Mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 (10.3%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(1.0-1.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e(-0.2-0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Survival outcomes of patients undergoing surgery after neoadjuvant chemotherapy or neoadjuvant chemo-immunotherapy.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;(Survival data are presented as mean survival time (months) with corresponding measures of variability, where applicable. Survival was estimated using the Kaplan\u0026ndash;Meier method and compared between groups using the log-rank test. A \u003cem\u003ep\u003c/em\u003e value \u0026lt;0.05 was considered statistically significant.)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1-Year Survival Rate (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Survival\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeoadjuvant Chemotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=47\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e89.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e19.8 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e18.1-21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeoadjuvant Chemoimmunotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e82.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e17.4 \u0026plusmn; 1.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e14.6-20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e DFS events included local recurrence, locoregional recurrence, distant metastasis, or death from any cause.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;(Mean DFS was estimated using the Kaplan\u0026ndash;Meier method, and comparisons between groups were performed using the log-rank test.)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1-Year DFS Rate (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean DFS\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeoadjuvant Chemotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=47\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e74.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e16.4 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e14.0-18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeoadjuvant Chemoimmunotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e86.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e18.4 \u0026plusmn; 1.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e16.2-20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Neoadjuvant chemoimmunotherapy, Locally advanced non-small cell lung cancer, Video-assisted thoracoscopic surgery, Perioperative outcomes, Surgical feasibility, Pathological response","lastPublishedDoi":"10.21203/rs.3.rs-8588919/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8588919/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTreatment approaches for locally advanced non–small cell lung cancer (NSCLC) require multidisciplinary evaluation. In recent years, the addition of immunotherapy to neoadjuvant chemotherapy has been reported to increase pathological response rates. This study aimed to compare surgical feasibility and early outcomes in patients with locally advanced NSCLC who received neoadjuvant chemotherapy or neoadjuvant chemoimmunotherapy and subsequently underwent anatomical lung resection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients who underwent surgery for locally advanced (Stage IIB–IIIB, 9th TNM) NSCLC in our clinic between January 2024 and September 2025 were retrospectively evaluated. Patients who received neoadjuvant chemotherapy were classified as Group A, while those who received neoadjuvant chemoimmunotherapy were classified as Group B. Clinical, surgical, and pathological data were compared using univariate and multivariate analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 76 patients were included in the study; 47 (61.8%) received neoadjuvant chemotherapy and 29 (38.2%) received neoadjuvant chemoimmunotherapy. Demographic characteristics were similar between the groups. Operation time was significantly longer in Group A (p = 0.005). Minimally invasive surgery (VATS) was performed at a significantly higher rate in Group B (p = 0.02). The postoperative pathological T stage was earlier in Group B (p = 0.019), and the pathological complete response rate was significantly higher in the chemoimmunotherapy group (p = 0.001). Although postoperative complication rates were similar between the groups, 30- and 90-day mortality rates were higher in Group B in univariate analysis. No significant difference was observed between the groups in terms of median survival (p = 0.353).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNeoadjuvant chemoimmunotherapy followed by surgery is a technically safe and feasible approach for patients with locally advanced non–small cell lung cancer. The addition of immunotherapy to neoadjuvant chemotherapy provides a significant pathological advantage, as evidenced by higher pathological complete response rates and earlier pathological T-stage compared with chemotherapy alone. These findings support the role of neoadjuvant chemoimmunotherapy in improving tumor regression and pathological downstaging without compromising surgical feasibility. However, careful patient selection and close postoperative follow-up are warranted due to the observed early mortality. Larger prospective, randomized studies with longer follow-up are required to clarify the impact of neoadjuvant chemoimmunotherapy on long-term survival outcomes.\u003c/p\u003e","manuscriptTitle":"Feasibility and Early Outcomes of Surgery After Neoadjuvant Chemoimmunotherapy in Locally Advanced Non–Small Cell Lung Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 12:25:43","doi":"10.21203/rs.3.rs-8588919/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-27T10:24:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T13:41:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-01T15:26:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-22T09:03:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18149437680483639727599525159965744997","date":"2026-03-17T10:08:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-17T02:50:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213738173179862635022893574719097252902","date":"2026-03-13T11:01:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80008717162914021521645816676255736729","date":"2026-03-13T01:51:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326704378424308075337617351507679975060","date":"2026-03-12T07:19:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T00:34:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271160768924870543285668429063917554527","date":"2026-03-12T00:25:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88201061254662441446489312224711654930","date":"2026-03-11T14:46:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T11:28:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T06:40:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-21T07:04:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2026-01-20T20:33:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6865c4cf-e195-4e91-9314-0602c0fbc4a7","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T18:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 12:25:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8588919","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8588919","identity":"rs-8588919","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}