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Background <p>Neoadjuvant immunochemotherapy has revolutionized non-small cell lung cancer(NSCLC) treatment. Periodontitis(PD) is one of the most prevalent oral diseases worldwide; however, its influence on the efficacy of neoadjuvant immunochemotherapy in NSCLC remains unclear. This study aimed to evaluate the association between PD status and severity with treatment outcomes following neoadjuvant immunochemotherapy in NSCLC.</p> Methods <p>Patients with initial stage IIA-IIIB NSCLC(excluding T4N2 and N3) who underwent surgery after neoadjuvant immunochemotherapy at three institutions between 2019 and 2025 were retrospectively reviewed. Stabilized inverse probability of treatment weighting(IPTW) was employed to balance baseline characteristics. The primary endpoint was major pathological response(MPR) rates.</p> Results <p>A total of 51 non-PD and 331 PD cases were included. After IPTW adjustment, PD was associated with lower MPR(33.5% vs. 43.5%, adjusted <i>P</i> = 0.036) and complete pathological response rates, as well as poorer early survival. Increasing PD severity was identified as an independent risk factor for diminished therapeutic efficacy. Specifically, grade II-III PD, but not grade I PD, was associated with poorer pathological response and preliminary survival outcomes. Interaction analyses revealed that such associative patterns were modified by age and body mass index(BMI). Subsequent stratified analyses confirmed that grade II-III PD was correlated with impaired pathological response and early survival in younger(age &lt; 65&#xa0;years) and non-overweight(BMI ≤ 24.0&#xa0;kg/m<sup>2</sup>) patients, but not in older(age ≥ 65&#xa0;years) and overweight(BMI &gt; 24.0&#xa0;kg/m<sup>2</sup>) patients.</p> Conclusion <p>PD may be an unfavorable prognostic factor associated with clinical outcomes of neoadjuvant immunochemotherapy in NSCLC. Grade II-III PD may be associated with worse pathological response and early survival, with more pronounced adverse effects in younger and non-overweight patients.</p> Graphical abstract <p></p>

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Impact of periodontitis on the efficacy of neoadjuvant immunochemotherapy in non-small cell lung cancer: a multi-center real-world study

  • 期刊论文

  • 发表日期：

    2026年7月2日

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  • Ling Li,
  • Hang Chen,
  • Hui Yin,
  • Yaofeng Shen,
  • Fan Shen,
  • Zimo Guo,
  • Baixue Zhai,
  • Yiping Wang,
  • Weicheng Kong,
  • Guodong Xu,
  • Qingquan Luo,
  • Jinsong Pan,
  • Hanbo Pan

摘要

Background

Neoadjuvant immunochemotherapy has revolutionized non-small cell lung cancer(NSCLC) treatment. Periodontitis(PD) is one of the most prevalent oral diseases worldwide; however, its influence on the efficacy of neoadjuvant immunochemotherapy in NSCLC remains unclear. This study aimed to evaluate the association between PD status and severity with treatment outcomes following neoadjuvant immunochemotherapy in NSCLC.

Methods

Patients with initial stage IIA-IIIB NSCLC(excluding T4N2 and N3) who underwent surgery after neoadjuvant immunochemotherapy at three institutions between 2019 and 2025 were retrospectively reviewed. Stabilized inverse probability of treatment weighting(IPTW) was employed to balance baseline characteristics. The primary endpoint was major pathological response(MPR) rates.

Results

A total of 51 non-PD and 331 PD cases were included. After IPTW adjustment, PD was associated with lower MPR(33.5% vs. 43.5%, adjusted P = 0.036) and complete pathological response rates, as well as poorer early survival. Increasing PD severity was identified as an independent risk factor for diminished therapeutic efficacy. Specifically, grade II-III PD, but not grade I PD, was associated with poorer pathological response and preliminary survival outcomes. Interaction analyses revealed that such associative patterns were modified by age and body mass index(BMI). Subsequent stratified analyses confirmed that grade II-III PD was correlated with impaired pathological response and early survival in younger(age < 65 years) and non-overweight(BMI ≤ 24.0 kg/m2) patients, but not in older(age ≥ 65 years) and overweight(BMI > 24.0 kg/m2) patients.

Conclusion

PD may be an unfavorable prognostic factor associated with clinical outcomes of neoadjuvant immunochemotherapy in NSCLC. Grade II-III PD may be associated with worse pathological response and early survival, with more pronounced adverse effects in younger and non-overweight patients.

Graphical abstract