Loading
Radiomics and Machine Learning in Medical Imaging / Lung Cancer Diagnosis and Treatment · Journal article
Cancers · September 10, 2026
A consensus or society position rather than new primary data.
This narrative review examines whether postoperative immunotherapy provides independent benefit after neoadjuvant chemoimmunotherapy and complete resection in resectable NSCLC, concluding that current phase III trials demonstrate activity but do not isolate the adjuvant ICI phase contribution. The authors propose pathological response, circulating tumor DNA-based molecular residual disease, and immune biomarkers as potential tools to refine which patients require postoperative treatment, while noting that prospective validation is needed before routine clinical application.
Narrative review. Patients with resectable NSCLC enrolled in or eligible for perioperative chemoimmunotherapy trials; literature on neoadjuvant therapy, surgery, and adjuvant ICI regimens. Intervention: Postoperative immune checkpoint inhibitor treatment after neoadjuvant chemoimmunotherapy and complete resection. Compared with: Omission of adjuvant ICI, de-escalation strategies, or intensification based on pathological response and biomarkers.
Pathological complete response identifies deepest-response group; major pathologic response represents intermediate state; non-major pathologic response or persistent nodal disease suggests higher relapse risk ctDNA-based MRD offers dynamic risk refinement and may identify patients with residual systemic disease, although prospective validation is required PD-L1, tumor mutational burden, tertiary lymphoid structures, B-cell signatures, radiomics, and pathomics provide complementary information but are not sufficient as standalone decision tools
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should recognize that current perioperative trials do not establish which patients absolutely require postoperative immunotherapy after complete resection and effective neoadjuvant therapy. Pathological response assessment offers practical risk stratification, but ctDNA-based MRD and biomarker-guided de-escalation require prospective validation before routine implementation.
A narrative review synthesizing evidence from phase III trials and biomarker studies to inform clinical decision-making about adjuvant immunotherapy after neoadjuvant chemoimmunotherapy in resectable NSCLC, without reporting original trial data or meta-analysis.
As stated by the source record.
Clinicians should recognize that current perioperative trials do not establish which patients absolutely require postoperative immunotherapy after complete resection and effective neoadjuvant therapy. Pathological response assessment offers practical risk stratification, but ctDNA-based MRD and biomarker-guided de-escalation require prospective validation before routine implementation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Background/Objectives: Perioperative chemoimmunotherapy has become an important curative-intent strategy for selected patients with resectable non-small cell lung cancer (NSCLC). However, most pivotal trials evaluate neoadjuvant therapy, surgery, and postoperative immune checkpoint inhibitor (ICI) treatment as an integrated regimen. Whether continued postoperative immunotherapy provides independent incremental benefit for all patients after effective neoadjuvant chemoimmunotherapy and complete resection remains unresolved. This review focuses on the adjuvant-phase dilemma and discusses how postoperative treatment may be refined according to response and residual risk. Methods: We performed a narrative review of major neoadjuvant and perioperative chemoimmunotherapy trials, indirect comparative analyses, pathological-response studies, circulating tumor DNA (ctDNA)-based molecular residual disease (MRD) evidence, immune biomarker studies, and emerging data in driver-positive and real-world populations. Particular attention was given to evidence informing postoperative continuation, de-escalation, or intensification after neoadjuvant chemoimmunotherapy. Results: Current phase III perioperative trials demonstrate clinically meaningful activity but do not isolate the independent contribution of the adjuvant ICI phase. Pathological response provides the most accessible postoperative risk signal: pathologic complete response identifies the deepest-response group, major pathologic response represents an intermediate state, and non-major pathologic response or persistent nodal disease suggests higher relapse risk. ctDNA-based MRD offers dynamic risk refinement and may help identify patients with residual systemic disease, although prospective validation is required before it can guide routine treatment omission or escalation. Programmed death-ligand 1 (PD-L1), tumor mutational burden, tertiary lymphoid structures, B-cell signatures, radiomics, and pathomics may provide complementary information but are not sufficient as standalone decision tools. Driver-positive disease requires molecularly stratified perioperative strategies rather than unselected extrapolation from epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)-negative trials. Conclusions: The key question in resectable NSCLC is shifting from whether perioperative immunotherapy is active to which patients truly require postoperative immunotherapy. Future trials should prospectively test response-guided strategies integrating pathological response, ctDNA-based MRD, immune contexture, baseline risk, and treatment feasibility.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.