诱导免疫化疗后初始不可切除的Ⅲ期非小细胞肺癌的转化手术：一项多中心研究

Conversion Surgery for Initially Unresectable Stage Ⅲ Nonsmall Cell Lung Cancer After Induction Treatment of Immunochemotherapy: A Multicenter Study.

作者信息

Wang Mingliang, Wang Xiaojun, Yang Ran, Geng Mingfei, Zhang Songlin, Yang Zebo, Huang Quanfu, Wang Sihua, Xu Shuangbing, Jiang Ke, Liao Yongde

机构信息

Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Thoracic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.

Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Clin Lung Cancer. 2025 May;26(3):e131-e140.e1. doi: 10.1016/j.cllc.2024.11.005. Epub 2024 Nov 28.

DOI:10.1016/j.cllc.2024.11.005

PMID:39848828

Abstract

BACKGROUND

Immuno-chemotherapy has demonstrated significant anti-tumor effects in patients with resectable nonsmall cell lung cancer (NSCLC). Additionally, for patients initially diagnosed with unresectable stage III NSCLC, induction immuno-chemotherapy may achieve tumor downstaging, enabling conversion to resectable disease allowing for by R0 resection. This study aimed to assess the effectiveness and safety of induction immuno-chemotherapy followed by conversion surgery in unresectable stage III NSCLC.

PATIENTS AND METHODS

A total of 113 patients with unresectable stage Ⅲ NSCLC who received induction immuno-chemotherapy at three institutions in China from March 2019 to April 2022 were retrospectively identified. After 2-4 cycles of immuno-chemotherapy, a multisiciplinary team (MDT) reassessed the tumor response and resectability in each case. Surgical resection was performed for patients who achieved tumor downstaging to resectable disease. Surgical and oncological outcomes of the patients were analyzed.

RESULTS

Of the 113 patients treated with immuno-chemotherapy, 79 (69.9%) achieved conversion to resectable state and underwent surgery. Surgical procedures included lobectomy in 55 (69.6%) patients, sleeve lobectomy in 14 (17.7%) patients, bilobectomy in 6 (7.6%) patients, and pneumonectomy in 4 (5.1%) patients, achieving an R0 resection rate of 98.7% (78/79). No surgical-related 30-day or 90-day mortalities were recorded, although 17 patients (21.5%) experienced postoperative complications. In terms of pathological response, 44 (55.7%) patients achieved major pathologic response and 25 (31.6%) patients achieved complete pathologic response. Median progression-free survival (PFS) and overall survival (OS) was not reached. The 12- and 24-month PFS rates were 82.3% and 72.2%, while OS rates were 94.9% and 84.5%, respectively.

CONCLUSION

Conversion surgery following immuno-chemotherapy is feasible and safe, yielding promising pathological responses and favorable survival outcomes for patients with unresectable stage III NSCLC.

摘要

背景

免疫化疗已在可切除的非小细胞肺癌（NSCLC）患者中显示出显著的抗肿瘤效果。此外，对于最初诊断为不可切除的Ⅲ期NSCLC患者，诱导免疫化疗可能实现肿瘤降期，从而使疾病转化为可切除状态，进而能够进行R0切除。本研究旨在评估诱导免疫化疗后行转化手术在不可切除的Ⅲ期NSCLC患者中的有效性和安全性。

患者与方法

回顾性纳入2019年3月至2022年4月在中国三家机构接受诱导免疫化疗的113例不可切除的Ⅲ期NSCLC患者。在进行2 - 4周期免疫化疗后，多学科团队（MDT）重新评估每例患者的肿瘤反应和可切除性。对实现肿瘤降期至可切除疾病的患者进行手术切除。分析患者的手术和肿瘤学结局。

结果

在接受免疫化疗的113例患者中，79例（69.9%）实现了向可切除状态的转化并接受了手术。手术方式包括55例（69.6%）患者行肺叶切除术，14例（17.7%）患者行袖状肺叶切除术，6例（7.6%）患者行双叶切除术，4例（5.1%）患者行全肺切除术，R0切除率为98.7%（78/79）。未记录到与手术相关的30天或90天死亡率，尽管17例患者（21.5%）出现了术后并发症。在病理反应方面，44例（55.7%）患者达到主要病理反应，25例（31.6%）患者达到完全病理反应。无进展生存期（PFS）和总生存期（OS）的中位数未达到。12个月和24个月的PFS率分别为82.3%和72.2%，而OS率分别为94.9%和84.5%。