Bao Feichao, Wang Jiaming, Shen Chen, Yu Fenghao, Jakopović Marko, Hao Xiuxiu, Chen Yang, Wang Yiyang, Gu Zhitao, Fang Wentao
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia.
Transl Lung Cancer Res. 2024 Aug 31;13(8):1964-1974. doi: 10.21037/tlcr-24-470. Epub 2024 Jul 18.
Immunotherapy has been recommended for neoadjuvant therapy in patients with locally advanced non-small cell lung cancer (NSCLC). However, its effect on surgical resection has not yet been examined. This study aimed to examine the effect of induction immunotherapy on surgical resection in terms of the surgical approach, resection extent, and perioperative recovery.
We performed a real-world study comprising consecutive patients with clinical stage IB-IIIB NSCLC who received surgical resection after induction immunotherapy from January 2019 to September 2021. The perioperative outcomes were compared in terms of the surgical approach and resection extent.
Among 68 patients, 37 (54.4%) achieved a clinical objective response. Standard resection was performed in 37 patients (54.4%), while extended resection was necessary in the other 31 patients (45.6%). Minimally invasive surgery (MIS) was attempted in 37 cases (54.4%), with only 1 (2.7%) conversion. MIS was significantly more commonly accomplished in patients with a clinical objective response than those without (67.6% 35.5%, P=0.008). Patients with a clinical objective response were more likely to have their tumors removed via MIS and/or standard resection (75.7% 51.6%, P=0.04), while those without a clinical objective response more often required extended resection using an open approach. Patients receiving standard resection or MIS had significantly better perioperative outcomes than those who underwent extended resection or thoracotomy (all P<0.05).
The results of this large single-center retrospective cohort indicate that in terms of a better clinical response, effective induction immunotherapy could help reduce the resection extent and/or provide more opportunities to perform MIS, resulting in better recovery.
免疫疗法已被推荐用于局部晚期非小细胞肺癌（NSCLC）患者的新辅助治疗。然而，其对手术切除的影响尚未得到研究。本研究旨在从手术方式、切除范围和围手术期恢复方面探讨诱导免疫疗法对手术切除的影响。
我们进行了一项真实世界研究，纳入了2019年1月至2021年9月期间接受诱导免疫疗法后接受手术切除的连续临床分期为IB-IIIB期NSCLC患者。比较了手术方式和切除范围方面的围手术期结果。
68例患者中，37例（54.4%）达到临床客观缓解。37例患者（54.4%）进行了标准切除，另外31例患者（45.6%）需要扩大切除。37例（54.4%）尝试了微创手术（MIS），仅1例（2.7%）转为开放手术。有临床客观缓解的患者比无临床客观缓解的患者更常完成MIS（67.6%对35.5%，P = 0.008）。有临床客观缓解的患者更有可能通过MIS和/或标准切除切除肿瘤（75.7%对51.6%，P = 0.04），而无临床客观缓解的患者更常需要采用开放手术进行扩大切除。接受标准切除或MIS的患者围手术期结果明显优于接受扩大切除或开胸手术的患者（所有P<0.05）。
这项大型单中心回顾性队列研究的结果表明，就更好的临床反应而言，有效的诱导免疫疗法有助于减少切除范围和/或提供更多进行MIS的机会，从而实现更好的恢复。
