新辅助化疗免疫治疗可为接受袖状肺叶切除术的患者带来生存优势。
Neoadjuvant chemoimmunotherapy confers survival advantage for patients undergoing sleeve lobectomy.
机构信息
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
出版信息
Eur J Cardiothorac Surg. 2024 Mar 29;65(4). doi: 10.1093/ejcts/ezae125.
OBJECTIVES
It has been demonstrated that neoadjuvant immune checkpoint inhibitor (ICI) plus chemotherapy was safe and feasible referred to neoadjuvant chemotherapy for patients with non-small cell lung cancer undergoing sleeve lobectomy. Nevertheless, no survival data were reported in the previous researches. Therefore, we conducted this study to compare neoadjuvant ICI plus chemotherapy versus neoadjuvant chemotherapy followed by sleeve lobectomy for long-term survival outcomes.
METHODS
Patients who underwent bronchial sleeve lobectomy following neoadjuvant ICI plus chemotherapy or neoadjuvant chemotherapy were retrospectively identified. Treatment response, perioperative outcomes, event-free survival and overall survival were compared between groups in the overall and the inverse probability of treatment weighting-adjusted cohort.
RESULTS
A total of 139 patients with 39 lung cancer recurrence and 21 death were included. Among them, 83 (59.7%) and 56 (40.3%) patients received neoadjuvant chemotherapy and neoadjuvant ICI plus chemotherapy, respectively. After inverse probability of treatment weighting, more patients achieved complete pathological response in the neoadjuvant ICI plus chemotherapy group (6.0% vs 26.3%, P < 0.001). There was no significant difference regarding overall postoperative complication (23.8% vs 20.2%, P = 0.624) and specific complications (all P > 0.05). Patients receiving neoadjuvant ICI plus chemotherapy had favourable event-free survival (hazard ratio 0.37, 95% confidence interval 0.16-0.85, P = 0.020) and overall survival (hazard ratio 0.23, 95% confidence interval 0.06-0.80, P = 0.021). Multivariable analysis revealed that neoadjuvant ICI plus chemotherapy was an independent predictor for favourable event-free survival (hazard ratio 0.37, 95% confidence interval 0.15-0.86, P = 0.020, adjusted for clinical TNM stage).
CONCLUSIONS
Neoadjuvant ICI plus chemotherapy was correlated with favourable long-term survival in patients with non-small cell lung cancer undergoing sleeve lobectomy.
目的
已经证明，新辅助免疫检查点抑制剂（ICI）联合化疗对于接受袖状肺叶切除术的非小细胞肺癌患者是安全且可行的，优于新辅助化疗。然而，之前的研究均未报道生存数据。因此，我们进行了这项研究，以比较新辅助ICI 联合化疗与新辅助化疗后行袖状肺叶切除术对长期生存结果的影响。
方法
回顾性纳入接受新辅助 ICI 联合化疗或新辅助化疗后行支气管袖状肺叶切除术的患者。在总人群和逆概率处理权重调整队列中比较两组的治疗反应、围手术期结局、无事件生存率和总生存率。
结果
共纳入 139 例患者，其中 39 例肺癌复发，21 例死亡。其中，83 例（59.7%）和 56 例（40.3%）患者分别接受新辅助化疗和新辅助 ICI 联合化疗。经逆概率处理权重调整后，新辅助 ICI 联合化疗组有更多患者达到完全病理缓解（6.0% vs. 26.3%，P < 0.001）。两组总体术后并发症发生率（23.8% vs. 20.2%，P = 0.624）和特定并发症发生率（均 P > 0.05）均无显著差异。接受新辅助 ICI 联合化疗的患者具有较好的无事件生存率（风险比 0.37，95%置信区间 0.16-0.85，P = 0.020）和总生存率（风险比 0.23，95%置信区间 0.06-0.80，P = 0.021）。多变量分析显示，新辅助 ICI 联合化疗是无事件生存率良好的独立预测因素（风险比 0.37，95%置信区间 0.15-0.86，P = 0.020，调整临床 TNM 分期后）。
结论
新辅助 ICI 联合化疗与非小细胞肺癌患者行袖状肺叶切除术后的长期生存结果改善相关。
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