新辅助免疫化疗与手术间隔时间对非小细胞肺癌手术病理结局的影响
Impact of the interval between neoadjuvant immunochemotherapy and surgery on surgical-pathological outcomes in non-small cell lung cancer.
作者信息
Chen Jiawei, Deng Hongsheng, He Jiaxi, Wang Zhufeng, Li Shuben
机构信息
Department of Thoracic Surgery and Oncology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
出版信息
Front Oncol. 2022 Sep 7;12:909726. doi: 10.3389/fonc.2022.909726. eCollection 2022.
INTRODUCTION
The interval between neoadjuvant immunochemotherapy and surgery in patients with non-small cell lung cancer (NSCLC) has not been well characterized. This study investigated the association between the time-to-surgery (TTS) interval and surgical-pathological outcomes.
METHOD
Clinical data of patients who received neoadjuvant immun-ochemotherapy followed by surgery for NSCLC between January 2019 and September 2021 were collected. The patients were divided into three groups based on TTS interval: the early-surgery group (ESG), the standard-surgery group (SSG), and the delayed-surgery group (DSG). The primary outcomes were objective response rate (ORR), major pathological response (MPR), and pathological complete response (pCR). The secondary endpoint was surgical outcome.
RESULTS
Of the 171 patients, 16 (9.4%) received surgery in ≤28 days, 49 (28.7%) received surgery within 29-42 days, and 106 (61.9%) received surgery in ≥43 days after neoadjuvant immunochemotherapy, with a median TTS of 46 days. The postoperative drainage of the ESG group (455.1 ml) was significantly less than that of the SSG group (680.7 ml) and the DSG group (846.5 ml; p = 0.037). However, the TTS interval did not influence the duration of the operation ( = 0.54), the extent of intraoperative bleeding ( = 0.60), or the length of postoperative hospital stay ( = 0.17). The ORR was observed in 69%, 51%, and 56% of patients in the ESG, the SSG, and the DSG, respectively ( = 0.46), and MPR occurred in 50%, 47%, and 58% ( = 0.38) of patients in the ESG, the SSG, and the DSG, respectively. Similarly, no statistically significant difference was found for pCR (ESG: 31%; SSG: 27%; DSG: 42%; = 0.14).
CONCLUSION
This retrospective study indicated that TTS exerts no significant effect on the feasibility and safety of surgery in the neoadjuvant immunochemotherapy setting of NSCLC. Analysis of the TTS interval revealed a tendency for delayed surgery to be associated with a pathological response in NSCLC, although this association was not statistically significant.
引言
非小细胞肺癌（NSCLC）患者新辅助免疫化疗与手术之间的间隔时间尚未得到充分研究。本研究调查了手术时间间隔（TTS）与手术病理结果之间的关联。
方法
收集2019年1月至2021年9月期间接受新辅助免疫化疗后行NSCLC手术的患者的临床资料。根据TTS间隔将患者分为三组：早期手术组（ESG）、标准手术组（SSG）和延迟手术组（DSG）。主要结局指标为客观缓解率（ORR）、主要病理缓解（MPR）和病理完全缓解（pCR）。次要终点为手术结果。
结果
171例患者中，16例（9.4%）在≤28天内接受手术，49例（28.7%）在29 - 42天内接受手术，106例（61.9%）在新辅助免疫化疗后≥43天接受手术，TTS中位数为46天。ESG组术后引流量（455.1 ml）显著少于SSG组（680.7 ml）和DSG组（846.5 ml；p = 0.037）。然而，TTS间隔对手术时间（p = 0.54）、术中出血量（p = 0.60）或术后住院时间（p = 0.17）无影响。ESG组、SSG组和DSG组患者的ORR分别为69%、51%和56%（p = 0.46），MPR分别发生在50%、47%和58%的患者中（p = 0.38）。同样，pCR在三组间无统计学显著差异（ESG：31%；SSG：27%；DSG：42%；p = 0.14）。
结论
这项回顾性研究表明，在NSCLC新辅助免疫化疗背景下，TTS对手术的可行性和安全性无显著影响。对TTS间隔的分析显示，延迟手术与NSCLC的病理缓解存在一定趋势，但这种关联无统计学意义。
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