Objective <p>This study aims to predict the pathological response of patients with non-small cell lung cancer (NSCLC) in prospective trials of neoadjuvant camrelizumab combined with chemotherapy by integrating the clinical characteristics, PET-associated parameters, and hematological indicators.</p> Methods <p>A prospective analysis was conducted among 24 patients undergoing surgery after neoadjuvant camrelizumab plus chemotherapy. ¹⁸F-Fluorodeoxyglucose (FDG) scans were performed before and after neoadjuvant therapy (pre-NAT, post-NAT). Tumor and secondary lymphoid organ metabolic parameters, along with circulating inflammatory and immune indicators, were measured and correlated with pathological response. Receiver operating characteristic (ROC) curve was used to assess biomarkers’ predictive accuracy.</p> Results <p>Major pathological response (MPR) and pathological complete response (pCR) were achieved in 45.8% (11/24) and 33.3% (8/24) of patients. Before treatment, patients who achieved a pCR had significantly greater SUVmax values (<i>p</i> = 0.011) than non-pCR patients. After treatment, the MPR group exhibited significantly lower SUVmax values than the non-MPR group (<i>p</i> = 0.048). The rate of change in the SUVmax (ΔSUVmax%) differed significantly between the pCR and non-pCR groups (<i>p</i> = 0.019) and between the MPR and non-MPR groups (<i>p</i> = 0.013). After NAT, the lymph nodes’ SUVmax in the ypN0 group was significantly lower than that in the ypN + group (<i>p</i> = 0.032). ROC analysis indicated that pre-NAT SUVmax and ΔSUVmax% best distinguished pCR and MPR patients, respectively, with AUCs of 0.82 (<i>p</i> = 0.012) and 0.80 (<i>p</i> = 0.014).</p> Conclusion <p>Pre-NAT SUVmax, and ΔSUVmax% are promising biomarkers for predicting pathological response to neoadjuvant camrelizumab and chemotherapy.</p> ClinicalTrials.gov ID <p>NCT06241807.</p>