新辅助化疗免疫治疗后 III 期 NSCLC 患者的放化疗与手术治疗：一项真实世界多中心回顾性研究。
Chemoradiotherapy versus surgery after neoadjuvant chemoimmunotherapy in patients with stage III NSCLC: a real-world multicenter retrospective study.
机构信息
Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin, 300060, China.
Department of Radiotherapy, Tianjin Cancer Hospital Airport Hospital, East 5Th Road, Tianjin Airport Economic District, Tianjin, 300308, China.
出版信息
Cancer Immunol Immunother. 2024 May 7;73(7):120. doi: 10.1007/s00262-024-03696-4.
PURPOSE
The optimal treatment after neoadjuvant chemoimmunotherapy for patients with stage III non-small cell lung cancer (NSCLC) is unclear. This study aimed at comparing the efficacy and safety of chemoradiotherapy and surgery after neoadjuvant chemoimmunotherapy in stage III NSCLC.
MATERIALS AND METHODS
We conducted a real-world multicenter retrospective study on patients with stage III NSCLC who received surgery or chemoradiotherapy after neoadjuvant chemoimmunotherapy between October 2018 and December 2022. Progression-free survival (PFS) and overall survival (OS) were assessed from the initiation of neoadjuvant treatment and estimated by the Kaplan‒Meier method. Univariate and multivariate Cox regression models were used to examine potential prognostic factors. One-to-one propensity score matching (PSM) was used to further minimize confounding.
RESULTS
A total of 239 eligible patients were enrolled, with 104 (43.5%) receiving surgery and 135 (56.5%) receiving CRT. After 1:1 PSM, 1- and 2-year PFS rates in patients receiving radical surgery (rSurgery group) vs. patients receiving definitive cCRT (dCCRT group) were 80.0% vs. 79.2% and 67.2% vs. 53.1%, respectively (P = 0.774). One- and 2-year OS rates were 97.5% vs. 97.4% and 87.3% vs. 89.9%, respectively (P = 0.558). Patients in the dCCRT group had a numerically lower incidence of distant metastases compared to those in the rSurgery group (42.9% vs. 70.6%, P = 0.119). The incidence of treatment-related adverse events was similar in both groups, except that the incidence of grade 3/4 hematological toxicity was significantly higher in the dCCRT group (30.0% vs. 10.0%, P = 0.025).
CONCLUSION
Following neoadjuvant chemoimmunotherapy, definitive concurrent chemoradiotherapy may achieve noninferior outcomes to radical surgery in stage III NSCLC.
目的
新辅助化疗免疫治疗后局部晚期 III 期非小细胞肺癌（NSCLC）患者的最佳治疗方法尚不清楚。本研究旨在比较新辅助化疗免疫治疗后局部晚期 III 期 NSCLC 患者接受放化疗和手术的疗效和安全性。
材料和方法
我们对 2018 年 10 月至 2022 年 12 月期间接受新辅助化疗免疫治疗后接受手术或放化疗的 III 期 NSCLC 患者进行了一项真实世界的多中心回顾性研究。无进展生存期（PFS）和总生存期（OS）从新辅助治疗开始进行评估，并通过 Kaplan-Meier 法进行估计。单变量和多变量 Cox 回归模型用于检查潜在的预后因素。采用 1:1 倾向评分匹配（PSM）进一步最小化混杂因素。
结果
共纳入 239 例符合条件的患者，其中 104 例（43.5%）接受手术，135 例（56.5%）接受 CRT。经过 1:1 PSM 后，接受根治性手术（rSurgery 组）和接受确定性 cCRT（dCCRT 组）的患者的 1 年和 2 年 PFS 率分别为 80.0% vs. 79.2%和 67.2% vs. 53.1%（P=0.774）。1 年和 2 年 OS 率分别为 97.5% vs. 97.4%和 87.3% vs. 89.9%（P=0.558）。dCCRT 组患者远处转移的发生率低于 rSurgery 组（42.9% vs. 70.6%，P=0.119）。两组治疗相关不良事件的发生率相似，但 dCCRT 组 3/4 级血液学毒性的发生率显著更高（30.0% vs. 10.0%，P=0.025）。
结论
新辅助化疗免疫治疗后，确定性同步放化疗可能在 III 期 NSCLC 中获得与根治性手术相当的结果。
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