Mohamed Shehab, Bertolaccini Luca, Casiraghi Monica, Petrella Francesco, Galetta Domenico, Guarize Juliana, de Marinis Filippo, Spaggiari Lorenzo
Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Updates Surg. 2023 Dec;75(8):2355-2363. doi: 10.1007/s13304-023-01644-y. Epub 2023 Sep 5.
Medical treatment has changed drastically in recent years, especially for advanced stages of non-small-cell lung cancer (NSCLC), for which the development of immunotherapy and molecular targeted therapy significantly increased survival and quality of life. This single-center retrospective study aimed to analyze the outcome predictors, the surrogate outcomes, and the patient-reported outcomes after neoadjuvant immunotherapy for initially unresectable NSCLC. Patients affected by an initially unresectable NSCLC and identified between March 2014 and December 2021 who received immunotherapy alone or in combination with platinum-based chemotherapy and/or radiotherapy were collected. Overall survival (OS) and disease-free survival (DFS) were estimated according to the Kaplan-Meier method. Patient-reported outcomes were recorded using the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life (QoL) Group questionnaire-Lung Cancer 29 Module to compare differences in symptoms and QoL at two different times, 30 days and 1 year after surgery. Surgical, pathological records, and patient-reported outcomes (at 30 days and 1 year after surgery) were reviewed. Complete pathological remission was achieved in 7 patients (36.8%) and major pathological remission in 3 patients (15.7%). The median overall survival in the study group is 19 months (range: 2-57.4). Of 19 patients, 16 (84.2%) are alive to date, of which 2 (10.5%) have a local recurrence. At 30 days from surgery, the main symptoms reported by EORTC Module were coughing, shortness of breath, the side effect of treatment, fear of progression, and surgery-related problems. Induction immunotherapy with or without chemotherapy can be considered for unresectable locally advanced NSCLC, and after the downstaging, the possibility of surgery could be re-evaluated in a multidisciplinary setting with high rates of R0 resection. In this selected and highly motivated group of patients, the QoL and symptoms after salvage surgeries are acceptable and even better than those reported in the literature.
近年来，医学治疗发生了巨大变化，尤其是对于非小细胞肺癌（NSCLC）的晚期阶段，免疫疗法和分子靶向疗法的发展显著提高了生存率和生活质量。这项单中心回顾性研究旨在分析初始不可切除的NSCLC新辅助免疫治疗后的预后预测因素、替代结局和患者报告结局。收集了2014年3月至2021年12月期间确诊为初始不可切除的NSCLC且接受单纯免疫治疗或联合铂类化疗和/或放疗的患者。根据Kaplan-Meier方法估计总生存期（OS）和无病生存期（DFS）。使用欧洲癌症研究与治疗组织（EORTC）生活质量（QoL）小组问卷-肺癌29模块记录患者报告结局，以比较术后30天和1年这两个不同时间点的症状和生活质量差异。回顾了手术、病理记录以及患者报告结局（术后30天和1年）。7例患者（36.8%）实现了完全病理缓解，3例患者（15.7%）实现了主要病理缓解。研究组的中位总生存期为19个月（范围：2-57.4个月）。19例患者中，16例（84.2%）至今仍存活，其中2例（10.5%）出现局部复发。术后30天，EORTC模块报告的主要症状为咳嗽、气短、治疗副作用、对疾病进展的恐惧以及与手术相关的问题。对于不可切除的局部晚期NSCLC，可考虑进行诱导免疫治疗（联合或不联合化疗），在降期后，可在多学科环境中重新评估手术可能性，R0切除率较高。在这群经过挑选且积极性很高的患者中，挽救性手术后的生活质量和症状是可以接受的，甚至优于文献报道。
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