新辅助化疗免疫治疗前后非小细胞肺癌患者淋巴结状态的预后意义：一项多中心回顾性研究
Prognostic Implications of Lymph Node Status in Non-Small-Cell Lung Cancer Patients Before and After Neoadjuvant Chemoimmunotherapy: A Multicenter Retrospective Study.
作者信息
Ma Ran, Yang Haitang, Ge Yong, Ma Tianyue, Wang Jiayi, Li Shuyuan, Feng Tianci, Feng Shoujie, Zhang Cheng, Sun Teng, Yao Feng, Yi Jun, Zhang Hao, Song Pingping
机构信息
Thoracic Surgery Laboratory, Xuzhou Medical University, Jiangsu, China; Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
出版信息
Clin Lung Cancer. 2025 Jul;26(5):370-383. doi: 10.1016/j.cllc.2025.04.004. Epub 2025 Apr 8.
BACKGROUND
In patients with non-small-cell lung cancer (NSCLC) treated with neoadjuvant chemoimmunotherapy, lymph node (LN) status is classified as ypN0 and ypN+. However, ypN0 includes patients who either had LN metastasis before neoadjuvant therapy (cN+/ypN0) or those who never developed LN metastasis (cN0/ypN0). The prognostic implications of these different LN statuses are not well understood.
METHODS
A retrospective analysis was conducted on patients with NSCLC who underwent surgery after neoadjuvant chemoimmunotherapy at 4 centers in China from 2019 to 2022. Patients were grouped by their LN status into natural'' N0 (cN0/ypN0), downstaged'' N0 (cN+/ypN0), and ypN+ (cN+/ypN+).
RESULTS
Out of 527 initially enrolled patients, 186 met the inclusion criteria: 34 (18.3%) had natural'' N0, 95 (51.1%) had downstaged'' N0, and 57 (30.6%) had ypN+. The median follow-up was 24 months (11-64 months). Disease-free survival (DFS) and overall survival (OS) were significantly lower in ypN+ compared to natural'' N0 and downstaged'' N0 (DFS: P < .001; OS: P < .001). However, no significant difference in either DFS (P = .695) or OS (P = .814) were observed between natural'' N0 and downstaged'' N0. Subgroup analysis showed that the MPR/ypN0 group had significantly better DFS compared to the non-MPR/ypN0 (P = .008), MPR/ypN+ (P = .028), and non-MPR/ypN+ groups (P < .001). For OS, MPR/ypN0 group was significantly superior to non-MPR/ypN+ (P < .001) and showed a trend toward better OS than non-MPR/ypN0 (P = .067) and MPR/ypN+ (P = .067). Notably, no significant differences were observed in either DFS (P = .908) or OS (P = .943) between non-MPR/ypN0 and MPR/ypN+ groups. The non-MPR/ypN+ group had the poorest survival outcomes in both DFS and OS.
CONCLUSIONS
Achieving ypN0 status after neoadjuvant chemoimmunotherapy strongly predicts favorable outcomes in patients with NSCLC, regardless of pretreatment cN status. Combining MPR with LN status effectively differentiates patient prognoses.
背景
在接受新辅助化疗免疫治疗的非小细胞肺癌（NSCLC）患者中，淋巴结（LN）状态分为ypN0和ypN+。然而，ypN0包括新辅助治疗前已有LN转移的患者（cN+/ypN0）或从未发生LN转移的患者（cN0/ypN0）。这些不同LN状态的预后意义尚未完全明确。
方法
对2019年至2022年在中国4个中心接受新辅助化疗免疫治疗后行手术的NSCLC患者进行回顾性分析。患者根据LN状态分为“自然”N0（cN0/ypN0）、“降期”N0（cN+/ypN0）和ypN+（cN+/ypN+）。
结果
在最初纳入的527例患者中，186例符合纳入标准：34例（18.3%）为“自然”N0，95例（51.1%）为“降期”N0，57例（30.6%）为ypN+。中位随访时间为24个月（11 - 64个月）。与“自然”N0和“降期”N0相比，ypN+患者的无病生存期（DFS）和总生存期（OS）显著更低（DFS：P <.001；OS：P <.001）。然而，“自然”N0和“降期”N0之间在DFS（P =.695）或OS（P =.814）方面均未观察到显著差异。亚组分析显示，MPR/ypN0组的DFS显著优于非MPR/ypN0组（P =.008）、MPR/ypN+组（P =.028）和非MPR/ypN+组（P <.001）。对于OS，MPR/ypN0组显著优于非MPR/ypN+组（P <.001），并且与非MPR/ypN0组（P =.067）和MPR/ypN+组（P =.067）相比，显示出OS更好的趋势。值得注意的是，非MPR/ypN0组和MPR/ypN+组之间在DFS（P =.908）或OS（P =.943）方面均未观察到显著差异。非MPR/ypN+组在DFS和OS方面的生存结果最差。
结论
新辅助化疗免疫治疗后达到ypN0状态强烈预示NSCLC患者的良好预后，无论预处理时的cN状态如何。将MPR与LN状态相结合可有效区分患者预后。
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