Ma Dongjie, Xu Yuan, Qin Yingzhi, Li Shanqing, Li Ji, Jiang Ying, Wang Mengzhao, Xu Yan, Zhao Jing, Chen Minjiang, Cheng Wuying, Hu Ke, Liu Hongsheng
Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Ann Transl Med. 2022 May;10(10):609. doi: 10.21037/atm-22-2271.
In recent years, neoadjuvant immunotherapy combined with chemotherapy has been used to treat locally advanced non-small cell lung cancer (NSCLC); however, no data are available to guide the selection of patients suitable for radical resection. In this paper, we report a clinical mode based on a multidisciplinary team (MDT).
We retrospectively analyzed the clinical data of patients with advanced NSCLC who were treated in our center between 26 December, 2019 and 1 October, 2021. These cases received an MDT assessment first. Eligible patients then received chemotherapy combined with personalized neoadjuvant immunotherapy. Adverse events were recorded. Chest computed tomography (CT) was performed every other cycle for tumor assessment. Radical resection was subsequently performed for potentially resectable tumors. Intraoperative conditions and surgical complications were recorded. The resected specimens were evaluated to determine the response to neoadjuvant therapy.
The MDT team selected a total of 35 patients (squamous cell carcinoma: n=26, adenocarcinoma: n=8, adenosquamous carcinoma: n=1) for radical resection following neoadjuvant immunotherapy combined with chemotherapy. According to the Response Evaluation Criteria in Solid Tumors (RECIST) findings, 1 patient had complete remission, 27 had partial remission, 6 had progressive disease, and 1 had stable disease. All participants underwent radical resection, including video-assisted thoracoscopic surgery [VATS; 32 (91.4%)], sleeve resection [7 (20.0%)], and multilobar resection [7 (20.0%)]. A total of 17 patients (48.6%) achieved complete pathological remission, and 10 (28.6%) achieved major pathological remission. After surgery, the pathological grade was reduced in 33 patients (94.2%); the RECIST findings were unrelated to postoperative pathological remission (P=0.15).
The MDT mode helps to select suitable patients for radical resection and results in satisfactory pathological remission.
近年来，新辅助免疫疗法联合化疗已被用于治疗局部晚期非小细胞肺癌（NSCLC）；然而，尚无数据可指导选择适合根治性切除的患者。在本文中，我们报告了一种基于多学科团队（MDT）的临床模式。
我们回顾性分析了2019年12月26日至2021年10月1日在本中心接受治疗的晚期NSCLC患者的临床资料。这些病例首先接受MDT评估。符合条件的患者随后接受化疗联合个性化新辅助免疫疗法。记录不良事件。每隔一个周期进行胸部计算机断层扫描（CT）以评估肿瘤。随后对潜在可切除的肿瘤进行根治性切除。记录术中情况和手术并发症。对切除的标本进行评估以确定对新辅助治疗的反应。
MDT团队共选择了35例患者（鳞状细胞癌：n = 26，腺癌：n = 8，腺鳞癌：n = 1）在新辅助免疫疗法联合化疗后进行根治性切除。根据实体瘤疗效评价标准（RECIST）结果，1例患者完全缓解，27例部分缓解，6例疾病进展，1例疾病稳定。所有参与者均接受了根治性切除，包括电视辅助胸腔镜手术[VATS；32例（91.4%）]、袖状切除[7例（20.0%）]和多叶切除[7例（20.0%）]。共有17例患者（48.6%）实现了完全病理缓解，10例（28.6%）实现了主要病理缓解。术后，33例患者（94.2%）的病理分级降低；RECIST结果与术后病理缓解无关（P = 0.15）。
MDT模式有助于选择适合根治性切除的患者，并能带来令人满意的病理缓解。
