Lin Yuqi, Zhang Yan, Pan Yang, Jin Xuanhong, Li Feng, Ru Junnan, Lin Jingwei, Hong Jiandong, Fei Zixuan, Luo Taobo, Shi Liang, Wu Leilei, Zeng Jian
Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China.
Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
J Thorac Dis. 2025 Aug 31;17(8):5816-5826. doi: 10.21037/jtd-2025-485. Epub 2025 Aug 28.
Although neoadjuvant immunochemotherapy (nICT) demonstrates considerable promise in improving survival rates for patients with non-small cell lung cancer (NSCLC), responses among individual patients can vary significantly, and not all patients attain optimal therapeutic outcomes. Our research seeks to discover a simple and cost-effective indicator for the dynamic evaluation of NSCLC patients' responses to nICT.
We enrolled 188 patients with surgically resectable NSCLC who received two to four cycles of nICT from January 1, 2021, and December 31, 2023, at Zhejiang Cancer Hospital. Subsequently, we analyzed the performance of the relative change in forced expiratory volume in one second (r-FEV1) and the relative change in carbon monoxide transfer factor (r-TLCO) as predictors of nICT efficacy. We employed binary logistic regression to assess the relationship between predictors and major pathological response (MPR). Kaplan-Meier (K-M) analysis and Cox regression were utilized to identify factors that predict prognosis. The primary endpoint of this study was event-free survival (EFS).
The male sex [odds ratios (OR) 8.86, 95% confidence interval (CI): 2.45-32.06, P<0.001], smoking history (OR 3.92, 95% CI: 2.01-7.64, P<0.001), radiological response evaluation (complete response/partial response stable disease/progressive disease, OR 0.30, 95% CI: 0.16-0.55, P<0.001), and histological type (lung squamous cell carcinoma lung adenocarcinoma, OR 4.96, 95% CI: 2.51-9.81, P<0.001) were found to be significantly associated with non-MPR. In the K-M analysis, we observed that low r-FEV1 was associated with a shorter EFS (log-rank P=0.01). Additionally, multivariable Cox analysis indicated that low r-FEV1 (HR 2.13, 95% CI: 1.01-4.50, P=0.047) remained significantly correlated with shorter EFS.
This study demonstrates that low r-FEV1 is a predictor of non- MPR and shorter EFS in patients with locally advanced NSCLC undergoing nICT. These findings support the use of r-FEV1 as a clinically actionable marker for predicting the efficacy of nICT. The integration of routine lung function tests (LFTs), particularly r-FEV1, into standard pretreatment evaluation protocols has the potential to improve risk stratification and inform therapeutic decision-making for patients with locally advanced NSCLC.
尽管新辅助免疫化疗（nICT）在提高非小细胞肺癌（NSCLC）患者生存率方面显示出巨大潜力，但个体患者的反应差异很大，并非所有患者都能获得最佳治疗效果。我们的研究旨在发现一种简单且经济高效的指标，用于动态评估NSCLC患者对nICT的反应。
我们纳入了188例可手术切除的NSCLC患者，这些患者于2021年1月1日至2023年12月31日在浙江省肿瘤医院接受了两到四个周期的nICT。随后，我们分析了一秒用力呼气量相对变化（r-FEV1）和一氧化碳弥散量相对变化（r-TLCO）作为nICT疗效预测指标的性能。我们采用二元逻辑回归评估预测指标与主要病理反应（MPR）之间的关系。采用Kaplan-Meier（K-M）分析和Cox回归来确定预测预后的因素。本研究的主要终点是无事件生存期（EFS）。
男性（优势比[OR] 8.86，95%置信区间[CI]：2.45 - 32.06，P < 0.001）、吸烟史（OR 3.92，95% CI：2.01 - 7.64，P < 0.001）、放射学反应评估（完全缓解/部分缓解 稳定疾病/疾病进展，OR 0.30，95% CI：0.16 - 0.55，P < 0.001）和组织学类型（肺鳞状细胞癌 肺腺癌，OR 4.96，95% CI：2.51 - 9.81，P < 0.001）被发现与非MPR显著相关。在K-M分析中，我们观察到低r-FEV1与较短的EFS相关（对数秩检验P = 0.01）。此外，多变量Cox分析表明，低r-FEV1（风险比[HR] 2.13，95% CI：1.01 - 4.50，P = 0.047）仍与较短的EFS显著相关。
本研究表明，低r-FEV1是接受nICT的局部晚期NSCLC患者非MPR和较短EFS的预测指标。这些发现支持将r-FEV1用作预测nICT疗效的临床可行标志物。将常规肺功能测试（LFTs），特别是r-FEV1，纳入标准的预处理评估方案，有可能改善风险分层，并为局部晚期NSCLC患者的治疗决策提供依据。
