拷贝数变异介导不可切除 IIIA 期-IIIB 期肺癌对诱导化疗免疫治疗的主要病理反应。

Copy number variations mediate major pathological response to induction chemo-immunotherapy in unresectable stage IIIA-IIIB lung cancer.

机构信息

Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China.

出版信息

Lung Cancer. 2023 Apr;178:134-142. doi: 10.1016/j.lungcan.2023.02.017. Epub 2023 Feb 24.

DOI:10.1016/j.lungcan.2023.02.017

PMID:36858002

Abstract

INTRODUCTION

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Despite this, evidence supporting optimal management of certain stages remains a topic of debate. In this retrospective study we examine the efficacy and safety, as well as exploring the biomarkers of neoadjuvant induction immuno-chemotherapy, in Chinese patients with unresectable stage III NSCLC.

METHODS

Patients with unresectable stage III NSCLC who were identified as driver mutation-negative and who received neoadjuvant chemo-immunotherapy were enrolled from three Chinese hospitals between Jan. 17, 2019, and Jan.17, 2022. Perioperative outcomes and survival data were collected. Retrospective biomarker exploration was performed in available baseline tumor samples and surgical specimens.

RESULTS

94 patients were enrolled and received chemo-immunotherapy as neoadjuvant treatment. 80 patients had squamous cell carcinoma, and 26 had stage IIIB disease. Surgery conversion rate was 74.4%, R0 resection rate was 98.4%. Of 64 patients who underwent surgery, major pathological response (MPR) rate was 65.6% and pathologic complete response (pCR) rate was 42.2%. 73% of patients with N2 disease demonstrated down-staging to N0. Treatment-related adverse events (TRAEs) occurred in 43 patients (45.7%) with anemia was the most common. The Grade ≥ 3 TRAEs rate was 3.2% (3/94). A significant association between copy number variation (CNV) ploidy was also found.

CONCLUSION

The combination treatment of immuno-chemotherapy for unresectable stage III NSCLC is not only effective but also has a favourable safety profile. For the first time we provide evidence that CNV status may be a predictive biomarker of MPR.

摘要

简介

非小细胞肺癌（NSCLC）是最常见的肺癌类型。尽管如此，支持某些阶段最佳管理的证据仍然是一个争议的话题。在这项回顾性研究中，我们检查了免疫化学新辅助治疗在不可切除的 III 期非小细胞肺癌中国患者中的疗效和安全性，并探索了生物标志物。

方法

从 2019 年 1 月 17 日至 2022 年 1 月 17 日，从三所中国医院招募了无法切除的 III 期 NSCLC 患者，这些患者被确定为驱动基因突变阴性，并接受了新辅助化疗免疫治疗。收集围手术期结果和生存数据。在可用的基线肿瘤样本和手术标本中进行了回顾性生物标志物探索。

结果

共纳入 94 例患者接受新辅助化疗免疫治疗。80 例患者为鳞状细胞癌，26 例患者为 IIIB 期。手术转化率为 74.4%，R0 切除率为 98.4%。在接受手术的 64 例患者中，主要病理缓解（MPR）率为 65.6%，病理完全缓解（pCR）率为 42.2%。73%的 N2 疾病患者降期至 N0。43 例（45.7%）患者发生治疗相关不良事件（TRAEs），最常见的是贫血。3.2%（3/94）的患者出现 3 级及以上 TRAEs。还发现了拷贝数变异（CNV）倍性之间的显著关联。