Dai Fuqiang, Wu Xiaoli, Wang Xintian, Li Kunkun, Wang Yingjian, Shen Cheng, Zhou Jinghai, Niu Huijun, Deng Bo, Tan Qunyou, Wang Ruwen, Guo Wei
Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, China.
Front Oncol. 2022 Oct 24;12:1022123. doi: 10.3389/fonc.2022.1022123. eCollection 2022.
Programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors displayed considerable advantages in neoadjuvant therapy of non-small cell lung cancer (NSCLC), but the specific application of neoadjuvant immunotherapy has not been well determined, and the long-term prognostic data of neoadjuvant immunochemotherapy combined with surgical resection of NSCLC remains limited. In this study, we intended to assess the efficacy of the neoadjuvant therapy of the PD-1 inhibitor and long-term prognosis in patients with resectable NSCLC.
We retrospectively analyzed NSCLC surgical patients treated with neoadjuvant therapy in our hospital, and divided them into a neoadjuvant chemotherapy group and a neoadjuvant immunotherapy combined with chemotherapy group. The propensity score matching method was used to evaluate the effectiveness of immunotherapy combined with chemotherapy in the treatment of resectable lung cancer, and the long-term prognosis of these two groups was compared.
A total of 62 cases were enrolled, including 20 patients (20/62, 32.26%) in the immunotherapy group and 42 patients (42/62, 67.74%) in the chemotherapy group. The clinical baseline data of these two groups were balanced. In the immunotherapy group, all patients had tumor regression in imaging finding (tumor regression ratio: 11.88% - 75.00%). In the chemotherapy group, 30 patients had tumor regression (tumor regression ratio: 2.70% - 58.97%). The R0 removal rates of cancers were comparable between the immunotherapy group and chemotherapy group (19/20, 95.00% vs. 39/42, 92.86%, P=1.000). The two groups were balanced in complete minimally invasive surgery, pneumonectomy, operative duration, blood loss, postoperative complications, and hospital stay. The immunotherapy group had more sleeve resection (36.84% vs. 10.26%, p=0.039) including bronchial sleeve and vascular sleeve, higher pathological complete response (pCR) rate (57.89% vs. 5.13%, P<0.001) and major pathologic response (MPR) rate (78.95% vs. 10.26%, P<0.001). There were no differences in survival curves for: smoker and non-smoker, squamous cell carcinoma and adenocarcinoma, or right lung cancer and left lung cancer. Moreover, patients who achieved MPR (including pCR) had significantly better overall survival (OS) and disease-free survival (DFS). Patients in immunotherapy group had significantly better OS and longer DFS than those in chemotherapy group.
In conclusion, neoadjuvant immunotherapy combined with chemotherapy can provide better OS and DFS and improving pCR and MPR rates by shrinking tumors.This study has been registered in the Chinese Clinical Trial Registry, number ChiCTR2200060433. http://www.chictr.org.cn/edit.aspx?pid=170157&htm=4.
程序性死亡蛋白1（PD-1）/程序性死亡配体1（PD-L1）抑制剂在非小细胞肺癌（NSCLC）新辅助治疗中显示出显著优势，但新辅助免疫治疗的具体应用尚未明确，NSCLC新辅助免疫化疗联合手术切除的长期预后数据仍然有限。在本研究中，我们旨在评估PD-1抑制剂新辅助治疗的疗效以及可切除NSCLC患者的长期预后。
我们回顾性分析了我院接受新辅助治疗的NSCLC手术患者，并将他们分为新辅助化疗组和新辅助免疫治疗联合化疗组。采用倾向评分匹配法评估免疫治疗联合化疗在可切除肺癌治疗中的有效性，并比较两组的长期预后。
共纳入62例患者，其中免疫治疗组20例（20/62，32.26%），化疗组42例（42/62，67.74%）。两组的临床基线数据均衡。免疫治疗组所有患者影像学检查均有肿瘤退缩（肿瘤退缩率：11.88% - 75.00%）。化疗组30例患者有肿瘤退缩（肿瘤退缩率：2.70% - 58.97%）。免疫治疗组和化疗组的肿瘤R0切除率相当（19/20，95.00%对39/42，92.86%，P = 1.000）。两组在完全微创手术、肺切除术、手术时间、失血量、术后并发症和住院时间方面均衡。免疫治疗组有更多的袖状切除术（36.84%对10.26%，p = 0.039），包括支气管袖状切除和血管袖状切除，更高的病理完全缓解（pCR）率（57.89%对5.13%，P < 0.001）和主要病理缓解（MPR）率（78.95%对10.26%，P < 0.001）。吸烟者与非吸烟者、鳞状细胞癌与腺癌、右肺癌与左肺癌的生存曲线无差异。此外。达到MPR（包括pCR）的患者总生存期（OS）和无病生存期（DFS）显著更好。免疫治疗组患者的OS显著优于化疗组，DFS更长。
总之，新辅助免疫治疗联合化疗可提供更好的OS和DFS，并通过缩小肿瘤提高pCR和MPR率。本研究已在中国临床试验注册中心注册，注册号为ChiCTR2200060433。http://www.chictr.org.cn/edit.aspx?pid=170157&htm=4。
