Zhang Weiming, Dai Tianfu, Wang Dongying, Zhu Yushu, Hua Weicong
Department of Pulmonary and Critical Care Medicine, Longyan People Hospital of Fujian, Longyan, Fujian, China.
The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
BMC Cancer. 2024 Dec 18;24(1):1522. doi: 10.1186/s12885-024-13311-5.
The efficacy of neoadjuvant immunotherapy in resectable non-small-cell lung cancer (NSCLC) is controversial. The aim of this study is to explore the efficacy of additional PD-1/PD-L1 inhibitors in the neoadjuvant treatment of resctable NSCLC.
Data sources included Cochrane Library, Embase, Web of Science, and PubMed from beginning of the database creation to May 2024. The primary outcomes of the study included event-free survival (EFS), overall survival (OS), pathological complete response (pCR), major pathological response (MPR).
Seven RCTs, including 2929 patients, were included in the analysis. The results showed that the experimental group had significantly higher rates of pCR (RR = 5.9, p < 0.001) and MPR (RR = 2.88, p < 0.001) compared to the control group. OS (HR = 0.57) and EFS (HR = 0.58) was also significantly improved in the experimental group. Subgroup analysis of EFS revealed that the benefit was higher in the East (HR = 0.56) than in the West (HR = 0.70). Additionally, the benefit seemed to rise with PD-L1 tumor cell proportion score (TPS) (TPS < 1%, HR = 0.76; 1% < TPS < 49%, HR = 0.56; TPS ≥ 50%, HR = 0.38). The benefit degree seemed to be higher in the III period patients (HR = 0.75) than I-II period patients (HR = 0.52). It is important to emphasize that smokers (HR = 0.54, p < 0.001) benefited from neoadjuvant immunotherapy but nonsmokers (HR = 0.68, p = 0.055) did not.
Neoadjuvant PD-1/PD-L1 inhibitor combined with chemotherapy can significantly improve the short-term and long-term prognosis of patients with resectable NSCLC. Moreover, the efficacy of this treatment regimen may be affected by different clinicopathological characteristics of patients.
新辅助免疫疗法在可切除的非小细胞肺癌（NSCLC）中的疗效存在争议。本研究旨在探讨额外使用PD-1/PD-L1抑制剂在可切除NSCLC新辅助治疗中的疗效。
数据来源包括Cochrane图书馆、Embase、Web of Science和PubMed，时间跨度从数据库创建之初至2024年5月。本研究的主要结局包括无事件生存期（EFS）、总生存期（OS）、病理完全缓解（pCR）、主要病理缓解（MPR）。
分析纳入了7项随机对照试验，共2929例患者。结果显示，与对照组相比，试验组的pCR（RR = 5.9，p < 0.001）和MPR（RR = 2.88，p < 0.001）发生率显著更高。试验组的OS（HR = 0.57）和EFS（HR = 0.58）也有显著改善。EFS的亚组分析显示，东方人群（HR = 0.56）的获益高于西方人群（HR = 0.70）。此外，获益程度似乎随PD-L1肿瘤细胞比例评分（TPS）升高而增加（TPS < 1%，HR = 0.76；1% < TPS < 49%，HR = 0.56；TPS≥50%，HR = 0.38）。III期患者（HR = 0.75）的获益程度似乎高于I-II期患者（HR = 0.52）。需要强调的是，吸烟者（HR = 0.54，p < 0.001）从新辅助免疫疗法中获益，但不吸烟者（HR = 0.68，p = 0.055）未获益。
新辅助PD-1/PD-L1抑制剂联合化疗可显著改善可切除NSCLC患者的短期和长期预后。此外，该治疗方案的疗效可能受患者不同临床病理特征的影响。
