Oya Yuko, Tanaka Ichidai
Department of Respiratory Medicine & Clinical Allergy, Fujita Health University, Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Respir Investig. 2025 Jul;63(4):532-541. doi: 10.1016/j.resinv.2025.04.001. Epub 2025 Apr 26.
Resectable non-small cell lung cancer (NSCLC) has a relatively poor prognosis owing to the risk of developing local or distant metastatic recurrence, even at stage I. To overcome the high recurrence rate, perioperative therapies have been rapidly developed through the combination of existing cytotoxic chemotherapies with immune checkpoint inhibitors (ICIs) and molecular targeted therapies. These new therapeutic strategies have significantly improved the prognosis of patients with stage II-III NSCLC and have been approved for clinical use. However, new challenges have emerged in the selection of the optimal perioperative treatment in clinical practice. First, it is currently difficult to determine which perioperative treatment is superior, preoperative or postoperative. Additionally, since surgery alone is curative in some patients, the addition of anticancer agents such as ICIs raises concerns regarding toxicity, as serious side effects during preoperative treatment may lead to an inability to perform the surgery itself. Moreover, because various perioperative treatments are still being developed, treatment options for perioperative care are expected to increase soon. To summarize the increasingly complex perioperative treatment of resectable NSCLC, this review provides a comprehensive summary of the clinical efficacies of current perioperative therapies and future directions based on basic background, patient selection, ongoing trials, and enhancing immunotherapy.
可切除的非小细胞肺癌（NSCLC）预后相对较差，因为即使在I期也有发生局部或远处转移性复发的风险。为了克服高复发率，通过将现有的细胞毒性化疗与免疫检查点抑制剂（ICI）和分子靶向疗法相结合，围手术期治疗得到了迅速发展。这些新的治疗策略显著改善了II-III期NSCLC患者的预后，并已被批准用于临床。然而，在临床实践中选择最佳围手术期治疗时出现了新的挑战。首先，目前很难确定哪种围手术期治疗更优，术前还是术后。此外，由于仅手术对某些患者具有治愈性，添加ICI等抗癌药物会引发对毒性的担忧，因为术前治疗期间的严重副作用可能导致无法进行手术本身。而且，由于各种围手术期治疗仍在开发中，预计围手术期护理的治疗选择很快会增加。为了总结可切除NSCLC日益复杂的围手术期治疗，本综述基于基本背景、患者选择、正在进行的试验以及增强免疫治疗，对当前围手术期治疗的临床疗效和未来方向进行了全面总结。
