新辅助免疫治疗对可切除非小细胞肺癌患者肺功能及围手术期结局的影响
[Impact of neoadjuvant immunotherapy on pulmonary function and perioperative outcomes in patients with resectable non-small cell lung cancer].
作者信息
Zhu Y, Li J Q, Chang Q, Qiang H P, Lu J H, Feng H, Shen Y C, Qian J L, Chu T Q
机构信息
Department of Pulmonary Function, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China.
Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China.
出版信息
Zhonghua Yi Xue Za Zhi. 2022 Feb 15;102(6):393-398. doi: 10.3760/cma.j.cn112137-20211009-02226.
To explore the effect of neoadjuvant immunotherapy on pulmonary function and the efficacy in patients with resectable non-small cell lung cancer. Data of 30 patients with non-small cell lung cancer (NSCLC) who received neoadjuvant immunotherapy before surgery in the Chest Hospital of Shanghai Jiaotong University from March 2018 to September 2021 were retrospectively collect. The efficacy and safety of neoadjuvant immunotherapy in the perioperative period and changes in pulmonary function of patients before and after neoadjuvant treatment were valuated. The patients were all-male with age of (61±8)years old, The major pathological response (MPR) rate of patients receiving neoadjuvant immunotherapy was 43%(13 cases), the pathologic complete response (pCR) rate was 37% (11 cases), disease control rate (DCR) was 97% (29 cases), objective response rate (ORR) was 67% (20 cases). The forced expiratory volume in one second (FEV1) after treatment was (2.59±0.63) L, and the ratio of FEV1 to the predicted value (FEV1%pred) was 85.27%±15.86%, which were significantly higher than those before treatment [(2.48±0.59)L, 81.73%±15.94%, respectively] (=0.013, 0.022, respectively). Forced vital capacity (FVC) after treatment was (3.59±0.77) L, which was also significantly higher than before [(3.47±0.76) L,=0.036]; while there were no statistical difference in FEV1/FVC and FVC accounted for the proportion of predicted values (FVC%pred) between before and after treatment (=0.084, 0.344, respectively). The ratio of carbon monoxide dispersion (DLCO) to the predicted value (DLCO%pred) decreased from 83.61%±13.10% to 78.69%±13.85% after treatment (=0.023). There was no significant difference in the incidence of postoperative complications between the DLCO%pred decreased group and the non-decreased group (3/18 vs 0/6; =0.546). Neoadjuvant immunotherapy can increase the rate of MPR and PCR, significantly increase FEV1 and FEV1%pred, but also lead to a decrease in DLCO%pred; neoadjuvant immunotherapy does not increase the incidence of postoperative complications.
探讨新辅助免疫治疗对可切除非小细胞肺癌患者肺功能的影响及疗效。回顾性收集2018年3月至2021年9月在上海交通大学胸科医院接受术前新辅助免疫治疗的30例非小细胞肺癌（NSCLC）患者的数据。评估新辅助免疫治疗在围手术期的疗效和安全性以及新辅助治疗前后患者肺功能的变化。患者均为男性，年龄（61±8）岁，接受新辅助免疫治疗患者的主要病理缓解（MPR）率为43%（13例），病理完全缓解（pCR）率为37%（11例），疾病控制率（DCR）为97%（29例），客观缓解率（ORR）为67%（20例）。治疗后一秒用力呼气容积（FEV1）为（2.59±0.63）L，FEV1与预测值的比值（FEV1%pred）为85.27%±15.86%，均显著高于治疗前[分别为（2.48±0.59）L、81.73%±15.94%]（分别为P=0.013、0.022）。治疗后用力肺活量（FVC）为（3.59±0.77）L，也显著高于治疗前[（3.47±0.76）L，P=0.036]；而治疗前后FEV1/FVC以及FVC占预测值的比例（FVC%pred）差异无统计学意义（分别为P=0.084、0.344）。一氧化碳弥散量（DLCO）与预测值的比值（DLCO%pred）治疗后从83.61%±13.10%降至78.69%±13.85%（P=0.023）。DLCO%pred降低组与未降低组术后并发症发生率差异无统计学意义（3/18 vs 0/6；P=0.546）。新辅助免疫治疗可提高MPR和pCR率，显著提高FEV1和FEV1%pred，但也导致DLCO%pred降低；新辅助免疫治疗不会增加术后并发症的发生率。
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