肺淋巴上皮瘤样癌患者的新辅助免疫治疗。
Neoadjuvant immunotherapy in patients with pulmonary lymphoepithelioma-like carcinoma.
机构信息
Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China; Shantou University Medical College, Shantou, China.
Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
出版信息
Lung Cancer. 2023 Jul;181:107220. doi: 10.1016/j.lungcan.2023.107220. Epub 2023 Apr 29.
OBJECTIVES
Neoadjuvant immunotherapy can be used to treat early-stage non-small-cell lung cancer; however, their effects on pulmonary lymphoepithelioma-like carcinomas (LELC) remain unclear.
MATERIALS AND METHODS
Thirty-nine patients with stages I-III LELC were treated with chemotherapy (Chemo) or neoadjuvant immune-checkpoint inhibitors (ICIs) with or without chemo (IO) before radical-intent surgery. Short-term outcomes included objective response rate (ORR), major pathologic response (MPR), pathologic complete response (PCR), and event-free survival. For comparison, we used IO to treat 63 patients with pulmonary squamous cell carcinomas (SQC) and 47 with adenocarcinomas (ADC). Propensity score matching was analyzed to minimize bias.
RESULTS
ORRs of the LELC-IO and LELC-Chemo groups were 62.5% and 42.9%, respectively (odds ratio, 2.2, 95% confidence interval, 0.423-11.678, p = 0.346). Seven (21.9%) and zero patients in LELC-IO and LELC-Chemo groups, respectively, reached PCR. MPR was identified in five (15.6%) of the 32 patients with LELC-IO. The 1-year progression-free survival rates were 96.9% and 71.4% in IO and Chemo groups, respectively (p > 0.05). However, no difference was observed in ORR, PCR, and MPR between LELC and SQC groups (ORR, 63.2% vs. 68.4%, p > 0.05; PCR, 21.1% vs. 47.4, p > 0.05; MPR, 42.1% vs. 57.9%, p > 0.05) and LELC and ADC groups (ORR, 58.8% vs. 41.2%, p > 0.05; PCR, 17.6% vs. 23.5%, p = 0.672; MPR, 29.4% vs. 47.1%, p > 0.05). The plasma Epstein-Barr virus (EBV) DNA level in a patient was altered posttreatment.
CONCLUSION
Patients with LELC could be benefit from neoadjuvant immunotherapy. Distinct histological subtypes demonstrated comparable efficacy with respect to neoadjuvant immunotherapy.
目的
新辅助免疫疗法可用于治疗早期非小细胞肺癌，但对肺淋巴上皮瘤样癌（LELC）的疗效尚不清楚。
材料与方法
39 例 I-III 期 LELC 患者接受化疗（Chemo）或新辅助免疫检查点抑制剂（ICIs）联合或不联合化疗（IO），然后行根治性手术。短期疗效包括客观缓解率（ORR）、主要病理缓解（MPR）、病理完全缓解（PCR）和无事件生存。为了比较，我们用 IO 治疗了 63 例肺鳞癌（SQC）和 47 例肺腺癌（ADC）患者。采用倾向评分匹配法尽量减少偏倚。
结果
LELC-IO 组和 LELC-Chemo 组的 ORR 分别为 62.5%和 42.9%（优势比，2.2，95%置信区间，0.423-11.678，p=0.346）。LELC-IO 组和 LELC-Chemo 组分别有 7 例（21.9%）和 0 例患者达到 PCR。32 例 LELC-IO 患者中有 5 例（15.6%）达到 MPR。IO 组和 Chemo 组的 1 年无进展生存率分别为 96.9%和 71.4%（p>0.05）。然而，LELC 组与 SQC 组（ORR，63.2% vs. 68.4%，p>0.05；PCR，21.1% vs. 47.4%，p>0.05；MPR，42.1% vs. 57.9%，p>0.05）和 LELC 与 ADC 组（ORR，58.8% vs. 41.2%，p>0.05；PCR，17.6% vs. 23.5%，p=0.672；MPR，29.4% vs. 47.1%，p>0.05）之间的 ORR、PCR 和 MPR 无差异。一名患者的血浆 EBV DNA 水平在治疗后发生改变。
结论
LELC 患者可从新辅助免疫治疗中获益。不同的组织学亚型在新辅助免疫治疗方面显示出相似的疗效。
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