Shao Weipeng, Zhao Chengwei, Li Hui, Sun Jian, Li Bobo, Liu Zhan, Chen Feng, Liu Jie, Guo Xiaokang, Guo Hongbo
Department of Thoracic Surgical Ward II, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
J Thorac Dis. 2024 Oct 31;16(10):6427-6440. doi: 10.21037/jtd-24-1011. Epub 2024 Oct 21.
In patients with non-small cell lung cancer (NSCLC) receiving neoadjuvant chemoimmunotherapy (NCIT), inconsistent pathological responses between the tumor and lymph nodes (LNs) are often observed. There has been limited evidence comparing the different responses of tumors and LNs in those patients. This retrospective real-world analysis intended to evaluate the clinical and pathological response of primary tumors and LNs, and the long-term outcomes in NSCLC patients after NCIT.
We included resectable NSCLC patients who had received neoadjuvant therapy and had available clinicopathological records. The progression-free survival (PFS) and overall survival (OS) outcomes were analyzed using survival analysis.
In total, 204 patients were included in the final analysis. Patients were predominantly male (85.8%) and ever-smokers (66.2%), with a median age of 63 years. No significant difference was observed in intraoperative bleeding (P=0.51 and P=0.54) and operation time (P=0.57 and P=0.58) between the major pathologic response (MPR) and pathological complete response (pCR) group, respectively. Patients who were male (pCR, P=0.01; MPR, P=0.004), with squamous cell carcinoma (SCC) (pCR, P=0.02; MPR, P=0.001), and overall response rate (ORR) (pCR, P<0.001; MPR, P<0.001) demonstrated significantly higher rates of pCR and MPR. The median follow-up time for all patients in this study was 23 months. Patients with MPR (P=0.004) and pCR (P=0.02) experienced prolonged PFS, but not OS (MPR, P=0.08; pCR, P=0.15). In terms of yield pathological tumor MPR (ypTMPR) and yield pathological LNs stage (ypN), Kaplan-Meier analyses demonstrated that there was a better PFS for the ypTMPR(+)/ypN(0) group, followed by ypTMPR(-)/ypN(0), ypTMPR(+)/ypN(0), and ypTMPR(-)/ypN(1+2) (P=0.01). The average PFS time was 35.7, 31.7, 29.4, and 28.7 months, respectively. After achieving MPR, the probability of local recurrence or distant metastasis was 7.3%, 25%, 23.5%, and 23.7%, respectively.
In this real-world study, the combination of tumor and LNs responses was significantly associated with prognosis, and we demonstrated that ypTMPR(+)/ypN(0) group had a better prognosis, followed by ypTMPR(-)/ypN(0), ypTMPR(+)/ypN(0), and ypTMPR(-)/ypN(1+2). We advocate for ypTMPR(+)/ypN(0) status as a better surrogate of PFS in resectable NSCLC patients after NCIT.
在接受新辅助化疗免疫治疗（NCIT）的非小细胞肺癌（NSCLC）患者中，经常观察到肿瘤与淋巴结（LNs）之间的病理反应不一致。比较这些患者肿瘤和淋巴结不同反应的证据有限。这项回顾性真实世界分析旨在评估NCIT后NSCLC患者原发肿瘤和淋巴结的临床及病理反应，以及长期预后。
我们纳入了接受过新辅助治疗且有可用临床病理记录的可切除NSCLC患者。使用生存分析对无进展生存期（PFS）和总生存期（OS）结果进行分析。
最终分析共纳入204例患者。患者以男性为主（85.8%），既往吸烟者居多（66.2%），中位年龄63岁。主要病理反应（MPR）组和病理完全缓解（pCR）组在术中出血量（P=0.51和P=0.54）及手术时间（P=0.57和P=0.58）方面均未观察到显著差异。男性患者（pCR，P=0.01；MPR，P=0.004）、鳞状细胞癌（SCC）患者（pCR，P=0.02；MPR，P=0.001）以及总缓解率（ORR）（pCR，P<0.001；MPR，P<0.001）的患者pCR和MPR率显著更高。本研究所有患者的中位随访时间为23个月。MPR（P=0.004）和pCR（P=0.02）的患者PFS延长，但OS未延长（MPR，P=0.08；pCR，P=0.15）。在产量病理肿瘤MPR（ypTMPR）和产量病理淋巴结分期（ypN）方面，Kaplan-Meier分析表明，ypTMPR(+)/ypN(0)组的PFS更好，其次是ypTMPR(-)/ypN(0)、ypTMPR(+)/ypN(0)和ypTMPR(-)/ypN(1+2)（P=0.01）。平均PFS时间分别为35.7、31.7、29.4和28.7个月。达到MPR后，局部复发或远处转移的概率分别为7.3%、25%、23.5%和23.7%。
在这项真实世界研究中，肿瘤和淋巴结反应的组合与预后显著相关，我们证明ypTMPR(+)/ypN(0)组预后更好，其次是ypTMPR(-)/ypN(0)、ypTMPR(+)/ypN(0)和ypTMPR(-)/ypN(1+2)。我们主张将ypTMPR(+)/ypN(0)状态作为NCIT后可切除NSCLC患者PFS的更好替代指标。
