Ding Yizong, Zhao Xiaojing, Christopoulos Petros, Geraci Travis C, Fu Yujie
Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Thoracic Oncology, Thoraxklinik and Translational Lung Research Center (member of the German Center for Lung Research, DZL) at Heidelberg University Hospital, Heidelberg, Germany.
J Thorac Dis. 2024 Jul 30;16(7):4645-4654. doi: 10.21037/jtd-24-908. Epub 2024 Jul 26.
Previously, stage-IIIB non-small cell lung cancer (NSCLC) has been considered inoperable. In recent years, neoadjuvant immunotherapy has shown encouraging efficacy in the treatment of advanced stage NSCLC in several trials. However, the effectiveness and safety of neoadjuvant immunotherapy in treating stage-IIIB NSCLC are still unknown. Therefore, we conducted this retrospective study to examine the outcomes of surgery after neoadjuvant immunotherapy combined with chemotherapy for stage-IIIB NSCLC.
Thirty patients with stage-IIIB NSCLC who were treated at the Department of Thoracic Surgery of Renji Hospital from January 2019 to September 2021 were analyzed retrospectively. Neoadjuvant immunotherapy combined with chemotherapy was administered prior to surgery. The curative effect was evaluated by imaging and pathological examinations.
The objective response rate (ORR) and disease control rate (DCR) of the patients after neoadjuvant therapy evaluated by imaging studies were 70% and 86.7%, respectively. Of the 30 patients, 19 (63%) underwent surgical resection, in which all achieved a complete R0 resection. The median operative time was 168 minutes (range, 75-295 minutes), and the average intraoperative blood loss was 215.3±258.4 mL. The median postoperative hospital stay was 8 days (range, 4-59 days). The major pathological response (MPR) rate was 73.7% (14/19), and the pathological complete response rate was 47.4% (9/19); 2/30 patients (6.7%) had postoperative complications, including two who developed bronchopleural fistulas and one mortality, from a postoperative pulmonary infection. The treatment-related adverse reactions were mainly grades 1-2. Only two patients had grade 3 anemia, and no grade 4 adverse reactions were observed.
Neoadjuvant immunotherapy and chemotherapy combined with surgery in patients with stage-IIIB NSCLC is safe and feasible. The patient outcomes and optimal number of neoadjuvant treatment cycles need to be explored and studied further.
此前，IIIB期非小细胞肺癌（NSCLC）被认为无法手术切除。近年来，新辅助免疫疗法在多项试验中对晚期NSCLC的治疗显示出令人鼓舞的疗效。然而，新辅助免疫疗法治疗IIIB期NSCLC的有效性和安全性仍不明确。因此，我们开展了这项回顾性研究，以探讨新辅助免疫疗法联合化疗治疗IIIB期NSCLC后的手术结局。
回顾性分析2019年1月至2021年9月在仁济医院胸外科接受治疗的30例IIIB期NSCLC患者。术前给予新辅助免疫疗法联合化疗。通过影像学和病理检查评估疗效。
影像学研究评估的新辅助治疗后患者的客观缓解率（ORR）和疾病控制率（DCR）分别为70%和86.7%。30例患者中，19例（63%）接受了手术切除，均实现了R0完全切除。中位手术时间为168分钟（范围75 - 295分钟），平均术中失血量为215.3±258.4 mL。术后中位住院时间为8天（范围4 - 59天）。主要病理缓解（MPR）率为73.7%（14/19），病理完全缓解率为47.4%（9/19）；30例患者中有2例（6.7%）出现术后并发症，包括2例发生支气管胸膜瘘，1例因术后肺部感染死亡。治疗相关不良反应主要为1 - 2级。仅2例患者出现3级贫血，未观察到4级不良反应。
新辅助免疫疗法联合化疗用于IIIB期NSCLC患者手术是安全可行的。患者结局和新辅助治疗周期的最佳数量需要进一步探索和研究。
