新辅助免疫检查点阻断（ICB）联合化疗改善了局部晚期非小细胞肺癌（NSCLC）的生存结果。然而，其对手术的影响尚未完全阐明。我们进行了系统回顾和荟萃分析，以比较可切除非小细胞肺癌新辅助化学免疫疗法和单独化疗的手术结果。检索了 PubMed 和 Embase，选择了评估新辅助 ICB 治疗可切除 NSCLC 的随机对照试验 (RCT)。使用随机效应模型汇总了手术和 R0 切除率、总体并发症发生率、治疗相关不良事件 (TRAE) 和导致手术取消的 AE 等结果的风险差 (RD) 和比值比 (OR)荟萃分析。我们还评估了总生存期 (OS) 与手术和安全结果之间的相关性。对涉及 3,387 名患者的 8 项随机对照试验进行了分析。新辅助化学免疫疗法与改善手术切除（RD 4.52%，95%置信区间 [CI] 0.95%-8.09%，p = 0.01）和 R0 切除（RD 4.04%，95% CI 1.69%-6.40%，p = 0.0008）相关）不会增加总体并发症（RD -0.13 %，95 % CI -5.14 %-4.88 %，p = 0.96），但由于 AE 导致手术取消增加（RD 1.15 %，95 % CI 0.25 %- 2.05 %；p = 0.01）和 3-4 级 TRAE（RD 3.42%，95% CI 0.33%-6.52%，p = 0.03）。 OS 与手术结果或 TRAE 没有显示出直接的显着相关性。新辅助化学免疫疗法可提高切除率，但会增加高级别 TRAE 和 AE，导致手术取消。尽管如此，通过改善手术结果，将 ICB 纳入新辅助治疗似乎是合理的，有可能提高局部晚期 NSCLC 患者的生存率。版权所有 © 2024 Elsevier Ltd。保留所有权利。

Neoadjuvant immune checkpoint blockade (ICB) combined with chemotherapy has improved survival outcomes in locally-advanced non-small cell lung cancer (NSCLC). However, its impact on surgery has not been fully elucidated. We performed a systematic review and meta-analysis to compare surgical outcomes between neoadjuvant chemoimmunotherapy and chemotherapy alone in resectable NSCLC. PubMed and Embase were searched to select randomized controlled trials (RCTs) evaluating neoadjuvant ICB therapy for resectable NSCLC. The risk difference (RD) and odds ratio (OR) of outcomes such as surgical and R0 resection rates, overall complication rates, treatment-related adverse events (TRAEs), and AEs leading to cancellation of surgery were pooled using the random-effect model meta-analysis. We also evaluated the correlations between overall survival (OS) and surgical and safety outcomes. Eight RCTs with 3,387 patients were analyzed. Neoadjuvant chemoimmunotherapy was associated with improved surgical resection (RD 4.52 %, 95 % confidence interval [CI] 0.95 %-8.09 %, p = 0.01) and R0 resection (RD 4.04 %, 95 % CI 1.69 %-6.40 %, p = 0.0008) without increasing overall complications (RD -0.13 %, 95 % CI -5.14 %-4.88 %, p = 0.96), but an increase in surgery cancellation due to AEs (RD 1.15 %, 95 % CI 0.25 %- 2.05 %; p = 0.01) and grade 3-4 TRAEs (RD 3.42 %, 95 % CI 0.33 %-6.52 %, p = 0.03). OS did not show a direct significant correlation with surgical outcomes or TRAEs. Neoadjuvant chemoimmunotherapy improves resection rates but increases high-grade TRAEs and AEs leading to surgery cancellation. Nevertheless, incorporating ICB into neoadjuvant approach appears reasonable by improving surgical outcomes, potentially leading to improved survival in patients with locally-advanced NSCLC.Copyright © 2024 Elsevier Ltd. All rights reserved.