Objective To investigate the impact of progression patterns (oligoprogression vs. systemic progression) and resistance types (primary vs. acquired) on survival outcomes in patients with advanced non-small cell lung cancer (NSCLC) following first-line immunotherapy combined with chemotherapy, and to explore their associations with biomarkers such as PD-L1.Methods A total of 579 patients with advanced NSCLC who experienced disease progression after first-line immuno-chemotherapy at Hunan Cancer Hospital between April 2018 and October 2022 were retrospectively enrolled. Patients were stratified by progression pattern into oligoprogression and systemic progression groups, and further subcategorized by resistance type. Propensity score matching (PSM) was used to balance baseline characteristics between groups and minimize confounding. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method and compared with the log-rank test. Binary logistic regression was used to identify factors associated with progression patterns. Tumor response was assessed per RECIST v1.1.Results Multivariate logistic regression identified male sex, smoking history, and squamous cell carcinoma histology as independent factors associated with a higher likelihood of oligoprogression. PD-L1 expression levels did not differ significantly between the two progression groups (P>0.05). Progression patterns demonstrated a time-dependent dynamic: systemic progression was more common early in treatment, while the proportion of oligoprogression increased among long-term survivors. The oligoprogression group had significantly longer median PFS and OS than the systemic progression group. Further analysis by resistance type revealed that patients with acquired resistance had significantly longer median PFS and OS than those with primary resistance, a trend consistent within both progression patterns. The objective response rate was significantly higher in the oligoprogression group (P<0.000 1).Conclusion Patients exhibiting oligoprogression, particularly those with acquired resistance, derive significant survival benefit, whereas those with primary resistance have a poorer prognosis. Treatment strategies should be dynamically adjusted based on progression patterns and resistance types to achieve personalized management.