Chen Yongjiang, Wang Rui, Lin Dong, Pan Hui, Yang Chao, Liu Hongxu, Huang Wei, Fan Jiang, Li Shuben
Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou, China.
Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Transl Lung Cancer Res. 2024 Nov 30;13(11):2868-2879. doi: 10.21037/tlcr-24-501. Epub 2024 Nov 18.
For locally advanced central lung cancer, lung autotransplantation allows for complete tumor resection while maximizing the preservation of lung parenchyma. Neoadjuvant chemotherapy combined with immunotherapy has shown benefits for patients with advanced lung cancer, providing longer progression-free survival compared to chemotherapy alone. This study aims to evaluate the feasibility and safety of neoadjuvant immuno-chemotherapy followed by lung autotransplantation in the treatment of locally advanced central non-small cell lung cancer (NSCLC).
We retrospectively analyzed ten patients with central NSCLC who underwent lung autotransplantation after neoadjuvant immuno-chemotherapy from June 2019 to December 2023. Of the grafts, there was 1 right upper lobe, 3 right lower lobe, 1 left lower lobe, 5 basal segments (3 right and 2 left). Nine cases were performed except one without graft perfusion. All patients were followed up regularly.
Ten cases received neoadjuvant immuno-chemotherapy [programmed cell death protein 1 (PD-1) inhibitor combined with platinum plus paclitaxel], the average number of cycles was 2.3±0.5 cycles, and the average interval between neoadjuvant therapy and surgery was 35.0±13.3 days. Following treatment, there was 1 complete response (CR), 6 partial responses (PRs), and 3 stable diseases (SDs). All cases achieved R0 resection, with 6 cases attaining complete pathological remission (CPR) and 2 cases exhibiting major pathological remission (MPR). No operative death occurred within 30 days. Six cases developed perioperative complications, with five cases being mild to moderate in severity, all of which recovered after standardized treatment. Only one instance of severe pulmonary artery embolism was observed, which improved with systemic anticoagulation therapy. The median follow-up time was 9.5 (range, 1.1-54.2) months. One patient had 4R lymph node recurrence (improved after radiotherapy and immunotherapy), and seven patients survived without recurrence.
Lung autotransplantation for advanced central NSCLC after neoadjuvant immuno-chemotherapy is feasible and safe, with maximal preservation of lung function and a high rate of R0 resection. This also demonstrates the advantages of organ preservation strategies. The procedure can be technically challenging, but lethal complications are uncommon. Overall, outcomes are satisfactory, and patients achieved reasonable survival during the follow-up period.
对于局部晚期中央型肺癌，肺自体移植能够实现肿瘤的完整切除，同时最大程度地保留肺实质。新辅助化疗联合免疫治疗已显示出对晚期肺癌患者有益，与单纯化疗相比，可提供更长的无进展生存期。本研究旨在评估新辅助免疫化疗后行肺自体移植治疗局部晚期中央型非小细胞肺癌（NSCLC）的可行性和安全性。
我们回顾性分析了2019年6月至2023年12月期间接受新辅助免疫化疗后行肺自体移植的10例中央型NSCLC患者。在移植肺中，有1例右肺上叶、3例右肺下叶、1例左肺下叶、5个肺基底段（3个右侧和2个左侧）。除1例未进行移植肺灌注外，其余9例均完成手术。所有患者均接受定期随访。
10例患者接受了新辅助免疫化疗[程序性细胞死亡蛋白1（PD-1）抑制剂联合铂类加紫杉醇]，平均化疗周期数为2.3±0.5个周期，新辅助治疗与手术之间的平均间隔时间为35.0±13.3天。治疗后，有1例完全缓解（CR）、6例部分缓解（PR）和3例病情稳定（SD）。所有病例均实现了R0切除，其中6例达到完全病理缓解（CPR），2例出现主要病理缓解（MPR）。30天内无手术死亡发生。6例患者出现围手术期并发症，其中5例为轻度至中度，经规范治疗后均康复。仅观察到1例严重肺动脉栓塞，经全身抗凝治疗后病情改善。中位随访时间为9.5（范围1.1 - 54.2）个月。1例患者出现4R淋巴结复发（放疗和免疫治疗后病情改善），7例患者存活且无复发。
新辅助免疫化疗后对晚期中央型NSCLC进行肺自体移植是可行且安全的，能最大程度地保留肺功能且R0切除率高。这也证明了器官保留策略的优势。该手术在技术上可能具有挑战性，但致命并发症并不常见。总体而言，结果令人满意，患者在随访期间获得了合理的生存期。
