Zhang Hu, Mao Xiaowei, Xu Jingwei, Song Lijiang, Huang Zhengwei, Li Yao, Sun Jiajing, Qian Jiali, Xu Shan, Minervini Fabrizio, Inamura Kentaro, He Zhengfu
Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Transl Lung Cancer Res. 2025 Feb 28;14(2):552-562. doi: 10.21037/tlcr-2025-25. Epub 2025 Feb 27.
Neoadjuvant therapy followed by surgery is the recommended treatment for patients with locally advanced lung cancer. No studies have examined the risk factors of postoperative pulmonary complications (PPCs) in this group of patients. The addition of immune checkpoint inhibitors (ICIs) can improve the efficacy of neoadjuvant therapy; however, it is unknown whether ICIs will also increase the PPC incidence. Thus, we conducted this study to identify the predictors of PPCs.
We reviewed the database of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University. Patients with non-adenocarcinoma non-small cell lung cancer (non-ADC NSCLC) who underwent surgery after neoadjuvant therapy were included. The clinical information was collected, the PPCs and mortality were evaluated.
The cohort in this study consisted of 108 patients. Among them, 36 had PPCs, and the incidence of PPCs was 33.3% (36/108). The majority of PPCs were prolonged time to chest tube removal and pneumonia. One patient died within 30 days due to serious postoperative complications. The mortality within 30 days was 0.9%. The addition of ICIs to neoadjuvant therapy did not increase the incidence of PPCs, but the operation time was longer in the ICI group. Multivariate analysis indicated that age, blood urea nitrogen (BUN) level and N2 stage may be superior predictors of PPCs.
The addition of ICIs did not increase the incidence of PPCs but did prolong the operation time. Age, BUN level, and N2 stage were excellent predictors of PPCs in non-ADC NSCLC patients treated with surgery after neoadjuvant therapy.
新辅助治疗后行手术是局部晚期肺癌患者的推荐治疗方法。尚无研究探讨该组患者术后肺部并发症（PPCs）的危险因素。免疫检查点抑制剂（ICIs）的加入可提高新辅助治疗的疗效；然而，ICIs是否也会增加PPCs的发生率尚不清楚。因此，我们开展了这项研究以确定PPCs的预测因素。
我们回顾了浙江大学医学院附属邵逸夫医院的数据库。纳入接受新辅助治疗后行手术的非腺癌非小细胞肺癌（非ADC NSCLC）患者。收集临床信息，评估PPCs和死亡率。
本研究队列包括108例患者。其中，36例发生PPCs，PPCs发生率为33.3%（36/108）。大多数PPCs为胸腔引流管拔除时间延长和肺炎。1例患者因严重术后并发症在30天内死亡。30天内死亡率为0.9%。新辅助治疗中加入ICIs并未增加PPCs的发生率，但ICI组手术时间更长。多因素分析表明，年龄、血尿素氮（BUN）水平和N2期可能是PPCs的较好预测因素。
加入ICIs并未增加PPCs的发生率，但延长了手术时间。年龄、BUN水平和N2期是新辅助治疗后接受手术的非ADC NSCLC患者PPCs的良好预测因素。
