Wu Yuqi, Li Renda, Tan Fengwei, Cao Jianzhong, Bi Nan
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Thorac Cancer. 2025 Jul;16(13):e15384. doi: 10.1111/1759-7714.15384. Epub 2025 Apr 17.
Since mediastinal lymph node dissection and radiotherapy (RT) have potential unclear impacts on pulmonary lymphatic system, this study aimed to assess the effectiveness of immune checkpoint inhibitors (ICIs) in recurrent/metastatic non-small-cell lung cancer (NSCLC) patients who previously received radical surgery with or without thoracic RT.
Clinical data of patients who underwent pulmonary lobectomy with systematic lymphadenectomy (2000.1.1-2021.7.2) and received immunotherapy after progression were retrospectively analyzed. Efficacy was mainly evaluated based on progression-free survival (PFS) from the start of the ICIs. Toxicity was defined as treatment discontinuation due to immune-related adverse effects (irAEs).
Ninety-five patients were enrolled in the final cohort and 30 (31.6%) patients received thoracic RT before ICI treatment. ICIs were administered as a first-line systematic treatment in 52.6% of patients. The median follow-up time was 14.7 months (95% confidence interval [CI] 13.3-18.7 months). The median PFS was 12.3 months (95% CI 8.5-36.6 months). Six (6.3%) patients had treatment suspended due to irAEs. Patients who received RT had comparable median PFS with the non-RT group (17.0 months vs. 11.1 months, p = 0.16). Similar toxicity rates were observed. Similar mPFS were reported in the stage III subgroup (RT vs. non-RT, 8.10 vs. 8.45 months, p = 0.86) or the subgroup treated by ICIs as primary systematic therapy (RT vs. non-RT, 13.6 vs. 16.1 months, p = 0.45).
ICIs remained effective in recurrent/metastatic NSCLC patients with radical surgery and RT did not significantly compromise therapeutic effects.
由于纵隔淋巴结清扫术和放射治疗（RT）对肺淋巴系统的潜在影响尚不清楚，本研究旨在评估免疫检查点抑制剂（ICI）在既往接受过或未接受过胸部放疗的根治性手术的复发/转移性非小细胞肺癌（NSCLC）患者中的疗效。
回顾性分析2000年1月1日至2021年7月2日期间接受肺叶切除术并系统性淋巴结清扫术且病情进展后接受免疫治疗的患者的临床资料。疗效主要基于ICI治疗开始后的无进展生存期（PFS）进行评估。毒性定义为因免疫相关不良反应（irAE）导致治疗中断。
最终队列纳入95例患者，30例（31.6%）患者在ICI治疗前接受了胸部放疗。52.6%的患者将ICI作为一线系统性治疗。中位随访时间为14.7个月（95%置信区间[CI] 13.3 - 18.7个月）。中位PFS为12.3个月（95% CI 8.5 - 36.6个月）。6例（6.3%）患者因irAE暂停治疗。接受放疗的患者与未接受放疗的组中位PFS相当（17.0个月对11.1个月，p = 0.16）。观察到相似的毒性率。在III期亚组（放疗组与未放疗组，8.10对8.45个月，p = 0.86）或接受ICI作为主要系统性治疗的亚组（放疗组与未放疗组，13.6对vs. 16.1个月，p = 0.45）中报告了相似的中位PFS。
ICI在接受根治性手术的复发/转移性NSCLC患者中仍然有效，放疗并未显著影响治疗效果。
