Xu Ke, Yang Haitang, Ma Wenyan, Fan Liwen, Sun Beibei, Wang Zhexin, Al-Hurani Mohammad Faisal, Schmid Ralph A, Yao Feng
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Clinical Statistical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
J Thorac Dis. 2021 Dec;13(12):6816-6826. doi: 10.21037/jtd-21-1195.
Locally-advanced lung squamous cell carcinoma represents a special subset that is challenging to resect completely with surgery alone. Immunotherapy has achieved great success in treating late-stage lung cancer. However, whether neoadjuvant immunotherapy can facilitate resection of initially locally-advanced and surgically-difficult locally-advanced lung squamous cell carcinoma remains to be investigated.
We retrospectively collected clinical records of locally-advanced lung squamous cell carcinoma patients who received neoadjuvant immunotherapy followed by surgery between 2018 and 2020 at a large academic thoracic cancer center.
A total of 23 patients (22 males, 1 female) with locally-advanced locally-advanced lung squamous cell carcinoma were included, initially clinically staged at IIIA (16, 69.6%), IIIB (n=4, 17.4%), IIB (n=2, 8.7%) and IIIC (n=1, 4.3%). The median interval between final treatment to surgery was 36 days (range, 25-93 days), without treatment-related delay in surgery. The neoadjuvant treatment resulted in a high rate of radical resection (n=20, 87.0%). The final histopathological examination demonstrated 6 (26.1%) cases with pathological complete response and 8 (34.8%) with pathological major response. Comparing with the computed tomography scan-based response, we observed a very low consistency (weighted kappa =0.122, P=0.315) between the computed tomography scan-based and final pathological evaluation. The median follow-up time was 510 days (range, 217-920 days). At the end of the follow-up, 1 patient died.
Our findings showed the clinical promise of neoadjuvant immunotherapy plus surgery for locally-advanced lung squamous cell carcinoma. Computed tomography scan displays a poor role in assessing the resectability after neoadjuvant immunotherapy.
局部晚期肺鳞状细胞癌是一个特殊的亚组，仅通过手术完全切除具有挑战性。免疫疗法在治疗晚期肺癌方面取得了巨大成功。然而，新辅助免疫疗法是否能促进最初局部晚期且手术困难的局部晚期肺鳞状细胞癌的切除仍有待研究。
我们回顾性收集了2018年至2020年期间在一家大型学术性胸癌中心接受新辅助免疫疗法后进行手术的局部晚期肺鳞状细胞癌患者的临床记录。
共纳入23例局部晚期肺鳞状细胞癌患者（22例男性，1例女性），最初临床分期为IIIA期（16例，69.6%）、IIIB期（4例，17.4%）、IIB期（2例，8.7%）和IIIC期（1例，4.3%）。最终治疗至手术的中位间隔时间为36天（范围25 - 93天），无手术相关的治疗延迟。新辅助治疗导致根治性切除率较高（20例，87.0%）。最终组织病理学检查显示6例（26.1%）为病理完全缓解，8例（34.8%）为病理主要缓解。与基于计算机断层扫描的反应相比，我们观察到基于计算机断层扫描的评估与最终病理评估之间的一致性非常低（加权kappa = 0.122，P = 0.315）。中位随访时间为510天（范围217 - 920天）。随访结束时，1例患者死亡。
我们的研究结果显示了新辅助免疫疗法联合手术治疗局部晚期肺鳞状细胞癌的临床前景。计算机断层扫描在评估新辅助免疫疗法后的可切除性方面作用不佳。
