Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Thoracic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Lung Cancer. 2023 Oct;184:107326. doi: 10.1016/j.lungcan.2023.107326. Epub 2023 Aug 11.
Neoadjuvant immunochemotherapy is effective in resectable NSCLC. However, its role in unresectable stage IIIB NSCLC patients remains controversial. This study aimed to demonstrate the efficacy and safety of neoadjuvant immunochemotherapy followed by surgical resection to treat initial unresectable stage IIIB NSCLC patients.
This study retrospectively analyzed 59 initial unresectable stage IIIB NSCLC patients who received induction pembrolizumab combined with chemotherapy between June 2019 and April 2022. Clinical characteristics, radiological and pathological responses, and survival outcomes were collected and evaluated.
Fifity-nine initial unresectable stage IIIB NSCLC patients were identified and divided into surgery (n = 23) and non-surgery (n = 36) groups with a median follow-up time of 15.0 months. The median PFS/DFS of the surgery group was significantly longer than the non-surgery group (not reached vs. 15.5 months, p = 0.0031). The median overall survival (OS) was not reached in both groups, and the OS rate was 100% (23/23) in the surgery group and 83.3% (30/36) in the non-surgery group. The pathological analysis suggested that 13 of 23 patients (56.5%) achieved major pathological response (MPR) or pathological complete response (pCR), and more squamous cell carcinoma cases were observed in the MPR group compared to the non-MPR group (p = 0.034). All patients in the surgery group had an R0 resection, and no surgical-related mortality was recorded; only three patients (13.0%) experienced any postoperative complications.
In this retrospective study, surgical resection after neoadjuvant immunochemotherapy was promising for initial unresectable stage IIIB NSCLC patients, with a high MPR rate and good surgical safety.
新辅助免疫化疗在可切除的非小细胞肺癌中有效。然而，其在不可切除的 IIIB 期非小细胞肺癌患者中的作用仍存在争议。本研究旨在证明新辅助免疫化疗后手术切除治疗初始不可切除的 IIIB 期非小细胞肺癌患者的疗效和安全性。
本研究回顾性分析了 2019 年 6 月至 2022 年 4 月期间接受诱导性 pembrolizumab 联合化疗的 59 例初始不可切除的 IIIB 期非小细胞肺癌患者。收集并评估了临床特征、影像学和病理学反应以及生存结果。
确定了 59 例初始不可切除的 IIIB 期非小细胞肺癌患者，并分为手术（n=23）和非手术（n=36）两组，中位随访时间为 15.0 个月。手术组的中位 PFS/DFS 明显长于非手术组（未达到 vs. 15.5 个月，p=0.0031）。两组的中位总生存期（OS）均未达到，手术组的 OS 率为 100%（23/23），非手术组为 83.3%（30/36）。病理分析表明，23 例患者中有 13 例（56.5%）达到主要病理缓解（MPR）或病理完全缓解（pCR），并且 MPR 组中更多的是鳞状细胞癌病例，而非 MPR 组（p=0.034）。手术组所有患者均行 R0 切除术，无手术相关死亡记录；仅有 3 例（13.0%）患者发生任何术后并发症。
在这项回顾性研究中，新辅助免疫化疗后手术切除对于初始不可切除的 IIIB 期非小细胞肺癌患者是有前景的，具有较高的 MPR 率和良好的手术安全性。
