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Efficacy and Time-Dependent Pattern of Consolidation Immunotherapy in Stage III Non-Small Cell Lung Cancer After Induction Chemoimmunotherapy and Radiotherapy: A Dual-Center Retrospective Cohort Study
by
Hao Zhang
1,†, 
Yujun Hu
2,†,
Ciming Sun
3,4,
Huimin Xu
5,
Yajing Liang
3,
Hui Liu
3,4,
Qiwen Li
3,4,* and
Shuohan Zheng
3,4,* 1
Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, China
2
Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
3
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
4
United Laboratory of Frontier Radiotherapy Technology of Sun Yat-sen University & Chinese Academy of Sciences Ion Medical Technology Co., Ltd., Guangzhou 510060, China
5
Department of Medical Oncology, Yiyang Center Hospital, Yiyang 413000, China
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2026, 18(13), 2035; https://doi.org/10.3390/cancers18132035 (registering DOI)
Submission received: 9 May 2026
/
Revised: 15 June 2026
/
Accepted: 18 June 2026
/
Published: 23 June 2026
(This article belongs to the Section Cancer Immunology and Immunotherapy)
Simple Summary
This dual-center retrospective cohort study assessed the efficacy and time-dependent pattern of consolidation immunotherapy in patients with unresectable stage III non-small cell lung cancer who achieved disease control after induction chemoimmunotherapy followed by radiotherapy. To reduce potential immortal time bias, only patients who remained alive and progression-free within 2 months after radiotherapy were included. Among 170 patients, 65 received consolidation immunotherapy and 105 did not. After a median follow-up of 33 months, consolidation immunotherapy was associated with improved progression-free survival (PFS) and overall survival. These benefits remained significant after stabilized inverse probability of treatment weighting, and multivariable analysis identified consolidation immunotherapy as an independent predictor of PFS. Exploratory sequential landmark Cox and restricted mean survival time analyses suggested that the survival benefit was more evident during the early treatment period, particularly around 8–10 months.
Abstract
Background/Objectives: The efficacy and time-dependent pattern of consolidation immunotherapy after induction chemoimmunotherapy and radiotherapy remain unclear in unresectable stage III non-small cell lung cancer (NSCLC). This study evaluated the efficacy and temporal pattern of consolidation immunotherapy in this population. Methods: This dual-center retrospective cohort study included patients with unresectable stage III NSCLC who achieved disease control after induction chemoimmunotherapy followed by definitive radiotherapy. To reduce potential immortal time bias, only patients who remained alive and progression-free within 2 months after radiotherapy were included. Patients were grouped according to receipt of consolidation immunotherapy. Survival outcomes were analyzed using stabilized inverse probability of treatment weighting, multivariable Cox regression, sequential landmark Cox analysis, and landmark restricted mean survival time analysis. Results: Among 170 eligible patients, 65 received consolidation immunotherapy and 105 did not. After a median follow-up of 33 months, consolidation immunotherapy was associated with longer PFS (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.35–0.78, p = 0.001) and OS (HR: 0.35, 95% CI: 0.18–0.65, p < 0.001). These benefits remained significant after weighting, and multivariable analysis identified consolidation immunotherapy as an independent predictor of improved PFS. Exploratory sequential landmark Cox and restricted mean survival time analyses suggested that the survival benefit was more evident during the early treatment period, particularly around 8–10 months. Conclusions: Consolidation immunotherapy was associated with improved survival, and its benefit appeared more evident during the early treatment period, particularly around 8–10 months. The optimal treatment duration requires further prospective validation.
