Li Zhixin, Wu Leilei, Wang Chong, Wang Shaodong, Chen Qiankun, He Wenxin
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Minimally Invasive Treatment Center, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
Ann Thorac Surg. 2025 Jul;120(1):118-128. doi: 10.1016/j.athoracsur.2024.10.007. Epub 2024 Oct 28.
There are limited data concerning pneumonectomy after preoperative induction therapy. Our study aimed to evaluate feasibility and safety of pneumonectomy after neoadjuvant immunotherapy in patients with non-small cell lung cancer by assessing postoperative outcomes.
A total of 1187 patients who underwent pneumonectomy for non-small cell lung cancer were retrospectively analyzed from 3 hospitals in China. Propensity score matching was adopted to form a balanced cohort between neoadjuvant therapy and non-neoadjuvant therapy groups. Univariable and multivariable logistic regression analyses were used to identify risk factors for postoperative morbidity. Efficacy and survival were compared for neoadjuvant therapy with or without immunotherapy.
The neoadjuvant group had larger tumors (4.7 ± 2.2 cm vs 3.9 ± 1.9 cm [P < .001]; cT4, 36.3% vs 19.1% [P < .001]), had a greater rate of N2 metastases (64.5% vs 33.3%; P < .001), and were at a more advanced clinical TNM stage (stage III, 89.4% vs 58.6%; P < .001). No significant difference in postoperative morbidity was observed between the groups before and after propensity score matching (43.5% vs 42.9% [P = .975]; 49.4% vs 41.9% [P = .162]). The complete pathologic response rate of neoadjuvant chemoimmunotherapy was significantly superior to that of chemotherapy alone (27.7% vs 2.0%; P < .001), and no significant difference in postoperative morbidity was observed in neoadjuvant therapy with or without immunotherapy. The neoadjuvant chemoimmunotherapy group also obtained a survival benefit with a 3-year overall survival (79.8% vs 67.5%; P = .001) and a 3-year event-free survival (63.3% vs 41.2%; P = .004).
After neoadjuvant therapy with immunotherapy, pneumonectomy can be safely performed in selected patients without increased postoperative morbidity.
关于术前诱导治疗后肺切除术的数据有限。我们的研究旨在通过评估术后结果来评估新辅助免疫治疗后非小细胞肺癌患者肺切除术的可行性和安全性。
对中国3家医院共1187例行非小细胞肺癌肺切除术的患者进行回顾性分析。采用倾向评分匹配法在新辅助治疗组和非新辅助治疗组之间形成一个均衡队列。采用单因素和多因素logistic回归分析确定术后发病的危险因素。比较新辅助治疗联合或不联合免疫治疗的疗效和生存率。
新辅助治疗组肿瘤更大（4.7±2.2 cm对3.9±1.9 cm [P<.001]；cT4，36.3%对19.1% [P<.001]），N2转移率更高（64.5%对33.3%；P<.001），临床TNM分期更晚（Ⅲ期，89.4%对58.6%；P<.001）。倾向评分匹配前后两组术后发病率无显著差异（43.5%对42.9% [P =.975]；49.4%对41.9% [P =.162]）。新辅助化疗联合免疫治疗的完全病理缓解率显著优于单纯化疗（27.7%对2.0%；P<.001），新辅助治疗联合或不联合免疫治疗术后发病率无显著差异。新辅助化疗联合免疫治疗组在3年总生存率（79.8%对67.5%；P =.001）和3年无事件生存率（63.3%对41.2%；P =.004）方面也获得了生存益处。
新辅助免疫治疗后，在选定患者中可安全地进行肺切除术，且术后发病率不会增加。
