Wang Qin, Qi Chen, Luo Jing, Xu Nan, Xu Mao-Tian, Qiang Yong, Zhang Chi, Shen Yi
Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Front Oncol. 2023 Dec 22;13:1239451. doi: 10.3389/fonc.2023.1239451. eCollection 2023.
The emergence of immune checkpoint inhibitors (ICIs) has brought about a paradigm shift in the treatment landscape of non-small cell lung cancer (NSCLC). Despite the promising long-term survival outcomes and optimization of pathological complete response (cPR) demonstrated by various studies such as Impower010 and Checkmate-816, the effectiveness of neoadjuvant immunotherapy in advanced resectable NSCLC remains a subject of debate. Although previous research has explored the connection between the efficacy of neoadjuvant therapy and surgical-related safety, limited studies have specifically investigated the surgical-related safety of neoadjuvant immunotherapy. Therefore, our study aims to assess the efficacy and surgical-related safety of neoadjuvant immunotherapy in advanced resectable non-small cell lung cancer.
We conducted a retrospective study on a cohort of 93 patients with stage IIIA-IIIC NSCLC who underwent neoadjuvant therapy and surgical resection. Among them, 53 patients received neoadjuvant immunotherapy, 18 patients underwent neoadjuvant chemotherapy while the remaining 22 underwent neoadjuvant targeted therapy. The patients were separated into further groups according to their pathological type. Data analyses were performed using Mann-Whitney U test, chi-square test.
All patients were categorized into six distinct groups. Notably, the neoadjuvant immunotherapy squamous carcinoma group exhibited a favorable edge over the neoadjuvant targeted squamous carcinoma group concerning the duration of drainage tube indwelling and the extent of lymph node dissection. Furthermore, the neoadjuvant immunotherapy adenocarcinoma group outperformed neoadjuvant targeted therapy adenocarcinoma counterpart in terms of achieving complete pathological response (cPR). Simultaneously, the neoadjuvant immunotherapy adenocarcinoma group surpassed the neoadjuvant chemotherapy adenocarcinoma group in the incidence of hydrothorax. Nevertheless, no statistically significant disparities were noted between the neoadjuvant immunotherapy squamous carcinoma group and the neoadjuvant chemotherapy carcinoma group.
Regarding surgical outcomes, neoadjuvant immunotherapy conferred notable advantages compared to conventional neoadjuvant chemotherapy and neoadjuvant targeted therapy for patients diagnosed with adenocarcinoma. In the case of squamous carcinoma, neoadjuvant immunotherapy exhibited superiority over neoadjuvant targeted therapy, although additional evidence is required to conclusively establish its precedence over neoadjuvant chemotherapy.
免疫检查点抑制剂（ICI）的出现给非小细胞肺癌（NSCLC）的治疗格局带来了范式转变。尽管Impower010和Checkmate - 816等多项研究显示出有前景的长期生存结果以及病理完全缓解（cPR）的优化，但新辅助免疫疗法在晚期可切除NSCLC中的有效性仍存在争议。虽然先前的研究探讨了新辅助治疗疗效与手术相关安全性之间的联系，但专门研究新辅助免疫疗法手术相关安全性的研究有限。因此，我们的研究旨在评估新辅助免疫疗法在晚期可切除非小细胞肺癌中的疗效和手术相关安全性。
我们对93例接受新辅助治疗和手术切除的IIIA - IIIC期NSCLC患者进行了回顾性研究。其中，53例患者接受了新辅助免疫疗法，18例患者接受了新辅助化疗，其余22例接受了新辅助靶向治疗。患者根据病理类型进一步分组。使用曼 - 惠特尼U检验、卡方检验进行数据分析。
所有患者分为六个不同组。值得注意的是，新辅助免疫疗法鳞状细胞癌组在引流管留置时间和淋巴结清扫范围方面比新辅助靶向鳞状细胞癌组具有优势。此外，新辅助免疫疗法腺癌组在实现完全病理缓解（cPR）方面优于新辅助靶向治疗腺癌组。同时，新辅助免疫疗法腺癌组在胸腔积液发生率方面超过了新辅助化疗腺癌组。然而，新辅助免疫疗法鳞状细胞癌组和新辅助化疗鳞状细胞癌组之间未观察到统计学上的显著差异。
关于手术结果，对于诊断为腺癌的患者，新辅助免疫疗法与传统新辅助化疗和新辅助靶向治疗相比具有显著优势。对于鳞状细胞癌，新辅助免疫疗法优于新辅助靶向治疗，尽管需要更多证据来最终确定其相对于新辅助化疗的优势。
