Qiu Yanjun, Yu Jinjiang, Guo Quanmin, Xu Jingyan
Department of Cardiothoracic Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou City, Zhejiang Province, People's Republic of China.
Cancer Manag Res. 2024 Sep 11;16:1221-1230. doi: 10.2147/CMAR.S453924. eCollection 2024.
The prognosis of locally advanced non-small cell lung cancer (NSCLC) remains poor despite the addition of neoadjuvant chemotherapy, as it has been shown to improve 5-year absolute benefit survival by only 5%. Recently, neoadjuvant immunotherapy with immune checkpoint inhibitors (ICIs), combined with chemotherapy has shown promise in the treatment of locally advanced NSCLC. For NSCLC invading the main bronchus, sleeve resection has become the preferred modality to avoid pneumonectomy and reserve more cardiac or pulmonary function and to reduce postoperative morbidity and mortality. However, there has been a paucity of evidence to evaluate the safety and efficacy of neoadjuvant chemoimmunotherapy on bronchial-vascular reconstruction owing to the limited number of patients treated by sleeve lobectomy. Despite promising initial results, key knowledge gaps remain, including the impact on bronchial-vascular reconstruction, biomarkers predictive of ICI response, and the potential for specific perioperative complications associated with neoadjuvant chemoimmunotherapy in the context of sleeve resection. This review summarizes the latest literature evidence on the efficacy and safety of neoadjuvant chemoimmunotherapy approaches to address the unmet needs of sleeve resection of NSCLC treatment, describes the biomarkers predictive of ICI responses, and perioperative outcomes of sleeve resection after neoadjuvant chemoimmunotherapy.
尽管新辅助化疗的加入，局部晚期非小细胞肺癌（NSCLC）的预后仍然很差，因为新辅助化疗仅能将5年绝对生存获益提高5%。最近，免疫检查点抑制剂（ICI）联合化疗的新辅助免疫疗法在局部晚期NSCLC的治疗中显示出前景。对于侵犯主支气管的NSCLC，袖状切除术已成为避免全肺切除术、保留更多心肺功能以及降低术后发病率和死亡率的首选术式。然而，由于接受袖状肺叶切除术治疗的患者数量有限，目前缺乏评估新辅助化疗免疫疗法对支气管血管重建的安全性和有效性的证据。尽管初步结果令人鼓舞，但关键的知识空白仍然存在，包括对支气管血管重建的影响、预测ICI反应的生物标志物以及在袖状切除术背景下与新辅助化疗免疫疗法相关的特定围手术期并发症的可能性。本综述总结了关于新辅助化疗免疫疗法疗效和安全性的最新文献证据，以满足NSCLC袖状切除术治疗的未满足需求，描述预测ICI反应的生物标志物以及新辅助化疗免疫疗法后袖状切除术的围手术期结果。
