Li Pengfei, Huang Kaili, Wu Qiang, Che Guowei, Zhou Qinghua
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Ann Surg Oncol. 2025 Jun 24. doi: 10.1245/s10434-025-17598-x.
Certain patients with stage IIIA-N2IIIB non-small cell lung cancer (NSCLC) have surgical opportunities after induction therapy. Two to four cycles of neoadjuvant chemoimmunotherapy (NCIT) are commonly used. However, whether the number of cycles of NCIT has an impact on the pathological response has not been extensively investigated. The intent of this study was to explore the impact of the number of NCIT cycles on the pathological response of patients with stage IIIA-N2IIIB NSCLC.
This retrospective single-center study reviewed patients with stage IIIA-N2IIIB NSCLC without positive driver genes who received two to four cycles of NCIT followed by complete resection. The primary endpoint was the major pathological response (MPR) rate. Univariate and multivariate logistic regression analyses were performed to explore the risk factors for the MPR. The objective response rate (ORR) was also compared between different cycles of NCIT.
Among the 170 patients included in our final analysis, the MPR rate was 58.24%, and the pathological complete response (pCR) rate was 37.06% in the overall cohort. The MPR rates were 58.97%, 62.50%, and 50.00% in the two-, three- and four-cycle NCIT groups, respectively. Multivariate regression analysis revealed that preoperative assessment of the radiographic response to NCIT, partial response/complete response (PR/CR), was the only independent prognostic factor for the MPR (p < 0.001).
We confirmed that preoperative PR/CR was important in predicting the MPR, whereas the number of cycles of NCIT did not influence the MPR rate in patients with stage IIIA-N2IIIB NSCLC.
部分IIIA-N2/IIIB期非小细胞肺癌（NSCLC）患者在诱导治疗后有手术机会。通常采用两至四个周期的新辅助化疗免疫疗法（NCIT）。然而，NCIT的周期数是否对病理反应有影响尚未得到广泛研究。本研究旨在探讨NCIT周期数对IIIA-N2/IIIB期NSCLC患者病理反应的影响。
这项回顾性单中心研究纳入了无驱动基因阳性的IIIA-N2/IIIB期NSCLC患者，这些患者接受了两至四个周期的NCIT，随后进行了根治性切除。主要终点是主要病理反应（MPR）率。进行单因素和多因素逻辑回归分析以探讨MPR的危险因素。还比较了不同周期NCIT的客观缓解率（ORR）。
在我们最终分析纳入的170例患者中，总体队列的MPR率为58.24%，病理完全缓解（pCR）率为37.06%。两周期、三周期和四周期NCIT组的MPR率分别为58.97%、62.50%和50.00%。多因素回归分析显示，术前对NCIT的影像学反应评估，即部分缓解/完全缓解（PR/CR），是MPR的唯一独立预后因素（p < 0.001）。
我们证实术前PR/CR对预测MPR很重要，而NCIT周期数对IIIA-N2/IIIB期NSCLC患者的MPR率没有影响。
