Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Ann Surg Oncol. 2024 Dec;31(13):8508-8513. doi: 10.1245/s10434-024-16284-8. Epub 2024 Sep 28.
Despite increasing use of immunotherapy in the treatment of various cancer types, understanding of its impact on postoperative complications still is limited. This study aimed to characterize the association between neoadjuvant immunotherapy and surgical outcomes for rectal, colon, anal, esophageal, lung (non-small cell), and oral cavity cancers.
Using the National Cancer Database (NCDB), the study selected patients ages 18-90 years who underwent non-palliative oncologic surgery between 2010 and 2020. The primary outcome was major morbidity, defined as hospital length of stay within the top decile of each surgery subtype, unplanned 30-day readmission, or 30-day mortality. Multivariable logistic regressions for major morbidity were performed to assess neoadjuvant immunotherapy effects by cancer type while controlling for patient demographics, Charlson-Deyo comorbidity index, cancer staging, procedure type, surgical approach, and other treatment (e.g., chemotherapy or radiotherapy).
Of 1,348,334 cases with any of the six cancer types, the study sample included 953,612 cases. Of these cases, 4771 (0.5 %) involved neoadjuvant immunotherapy, and 948,841 (99.5 %) did not. The pooled odds ratio was 0.98 (95% confidence interval [CI] 0.81-1.19). Neoadjuvant immunotherapy was not significantly associated with major morbidity after surgery for rectal (adjusted odds ratio [aOR], 0.83; 95% CI 0.60-1.16), colon (aOR, 1.27; 95% CI 0.87-1.85), anal (aOR, 1.90; 95 % CI 0.16-23.15), esophageal (aOR, 0.35; 95% CI 0.08-1.49), lung (non-small cell) (aOR, 1.06; 95% CI 0.65-1.73), or oral (aOR, 1.10; 95% CI 0.61-2.00) cancer.
Neoadjuvant immunotherapy is not significantly associated with postoperative complications across several cancer types. As the largest study on neoadjuvant immunotherapy postoperative complications, this study suggests that surgery in the setting of neoadjuvant immunotherapy is safe.
尽管免疫疗法在治疗各种癌症类型中的应用日益增多，但人们对其对术后并发症影响的了解仍有限。本研究旨在描述新辅助免疫疗法与直肠、结肠、肛门、食管、肺（非小细胞）和口腔癌的手术结果之间的关联。
本研究使用国家癌症数据库（NCDB），选取了 2010 年至 2020 年间接受非姑息性肿瘤手术的年龄在 18-90 岁的患者。主要转归为主要发病率，定义为每种手术亚型中住院时间最长的前十分位数、计划外 30 天再入院或 30 天死亡率。对主要发病率进行多变量逻辑回归分析，以评估癌症类型的新辅助免疫疗法效果，同时控制患者人口统计学、Charlson-Deyo 合并症指数、癌症分期、手术类型、手术方法和其他治疗方法（例如化疗或放疗）。
在 1348334 例有六种癌症类型之一的病例中，本研究样本包括 953612 例。在这些病例中，4771 例（0.5%）接受了新辅助免疫治疗，948841 例（99.5%）未接受。汇总的优势比为 0.98（95%置信区间[CI] 0.81-1.19）。新辅助免疫疗法与直肠（调整后的优势比[aOR]，0.83；95%CI 0.60-1.16）、结肠（aOR，1.27；95%CI 0.87-1.85）、肛门（aOR，1.90；95%CI 0.16-23.15）、食管（aOR，0.35；95%CI 0.08-1.49）、非小细胞肺癌（aOR，1.06；95%CI 0.65-1.73）或口腔癌（aOR，1.10；95%CI 0.61-2.00）手术后的主要发病率之间没有显著关联。
新辅助免疫疗法与多种癌症类型的术后并发症无显著关联。作为新辅助免疫疗法术后并发症的最大研究，本研究表明新辅助免疫疗法背景下的手术是安全的。
