Objective:

To evaluate the association between ypN status and survival outcomes after neoadjuvant chemoimmunotherapy in resectable NSCLC, addressing the significance of this relationship in improving patient prognostication.

Key Findings:

• Unfavorable post-treatment nodal status was associated with significantly poorer OS (pooled HR 4.75, 95% CI 2.38 - 9.47; P < 0.00001), indicating a substantial increase in risk.
• Unfavorable post-treatment nodal status was also associated with poorer DFS (pooled HR 3.54, 95% CI 1.71–7.33; P = 0.0007), suggesting a critical need for monitoring.
• Combined major pathological response (MPR)-ypN classification may further stratify prognosis, highlighting the complexity of post-treatment assessments.

Interpretation:

Unfavorable ypN status after neoadjuvant chemoimmunotherapy is linked to worse survival outcomes in resectable NSCLC, but findings are based on only two studies and require cautious interpretation, emphasizing the need for further research.

Limitations:

• Only two retrospective studies included in the meta-analysis for OS and DFS, which limits the generalizability of the findings.
• Variability in sample size, subgroup definitions, follow-up duration, and survival endpoints across studies may affect the robustness of the conclusions.

Conclusion:

Unfavorable post-treatment nodal status is associated with poorer survival outcomes in resectable NSCLC, but further prospective validation is needed to confirm these findings and standardize pathological classifications.