Mazzella Antonio, Maiorca Sebastiano, Nicolosi Giuseppe, Maisonneuve Patrick, Passaro Antonio, Casiraghi Monica, Bertolaccini Luca, de Marinis Filippo, Spaggiari Lorenzo
Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy.
Department of Oncology and Haemato-Oncology, University of Milan, 20122 Milan, Italy.
J Clin Med. 2025 Apr 1;14(7):2419. doi: 10.3390/jcm14072419.
We aimed at assessing our experience at the European Institute of Oncology in order to evaluate the peri- and immediately post-operative impact of neoadjuvant chemotherapy in patients who underwent pneumonectomy for NSCLC. We retrospectively reviewed the outcomes and medical records of patients undergoing pneumonectomy (2010-2024). We compared pre-, peri- and post-operative outcomes of patients treated with induction chemotherapy and subsequent pneumonectomy with patients who underwent surgery directly. Differences in their distribution between study arms were assessed using the chi-square test for categorical variables or the Mantel-Haenszel test for trend for ordinal variables. We tested normality of the distribution of continuous variables using the Shapiro-Wilk test. We used logistic regression to quantify the risk of various outcomes (complications, 30-day and 12-day mortality) in patients who received neoadjuvant chemotherapy. Risks were expressed as odds ratios (ORs) with 95% confidence intervals (CIs adjusted for age (<60, 60-64, 65-69, ≥70 years), sex and comorbidities (cardiovascular, pulmonary or previous cancer). We observed a higher frequency of post-operative respiratory complications in patients who underwent neoadjuvant therapy and pneumonectomy compared to those who only underwent surgery (11.4% vs. 18.5%; = 0.05). After adjustment for age, sex and comorbidities we observed a significantly higher rate of pulmonary complications (OR 1.95; 95% CI 1.09-3.47; = 0.02), ARDS (OR 2.88; 95% CI 1.26-6.59; = 0.02) and 30-day mortality rate (OR 8.19; 95% CI 1.33-50.3; = 0.02) in pre-treated patients. It is therefore strongly recommended to study and select potentially eligible patients in an extremely meticulous way before starting the neoadjuvant treatment, and to thoroughly re-evaluate the cardiorespiratory status after inductive therapy, before surgery.
我们旨在评估欧洲肿瘤研究所的经验，以评估新辅助化疗对接受非小细胞肺癌肺切除术患者围手术期及术后即刻的影响。我们回顾性分析了2010年至2024年接受肺切除术患者的结局和病历。我们比较了接受诱导化疗后行肺切除术患者与直接接受手术患者的术前、术中和术后结局。使用卡方检验评估分类变量研究组间分布差异，使用Mantel-Haenszel检验评估有序变量趋势。使用Shapiro-Wilk检验检验连续变量分布的正态性。我们使用逻辑回归量化接受新辅助化疗患者出现各种结局（并发症、30天和12天死亡率）的风险。风险以比值比（OR）表示，并给出95%置信区间（CI），根据年龄（<60岁、60 - 64岁、65 - 69岁、≥70岁）、性别和合并症（心血管、肺部或既往癌症）进行调整。我们观察到，与仅接受手术的患者相比，接受新辅助治疗和肺切除术的患者术后呼吸并发症发生率更高（11.4%对18.5%；P = 0.05）。在对年龄、性别和合并症进行调整后，我们观察到预处理患者的肺部并发症发生率显著更高（OR 1.95；95% CI 1.09 - 3.47；P = 0.02）、急性呼吸窘迫综合征发生率显著更高（OR 2.88；95% CI 1.26 - 6.59；P = 0.02）以及30天死亡率显著更高（OR 8.19；95% CI 1.33 - 50.3；P = 0.02）。因此，强烈建议在开始新辅助治疗前，以极其细致的方式研究和选择潜在符合条件的患者，并在诱导治疗后、手术前彻底重新评估心肺状况。
