新辅助免疫治疗对可切除的非小细胞肺癌患者肺功能的影响及疗效分析

Impact of neoadjuvant immunotherapy on pulmonary function and perioperative outcomes in patients with resectable non-small cell lung cancer

目的探索新辅助免疫治疗对可切除的非小细胞肺癌患者肺功能的影响及疗效。方法回顾性收集2018年3月至2021年9月期间在上海交通大学附属胸科医院术前接受新辅助免疫治疗的30例肺癌患者的资料。对新辅助免疫治疗在围手术期的疗效和安全性进行评估,比较新辅助治疗前后患者肺功能的变化。结果30例患者年龄为(61±8)岁,均为男性。接受新辅助免疫治疗的患者主要病理缓解(MPR)率为43%(13例),完全病理缓解(pCR)率为37%(11例),疾病控制率(DCR)97%(29例),客观缓解率(ORR)67%(20例)。治疗后1秒用力呼气容积(FEV1)为(2.59±0.63)L,FEV1占预计值的比例(FEV1%pred)为85.27%±15.86%,均高于治疗前[分别为(2.48±0.59)L、81.73%±15.94%](P=0.013、0.022)。治疗后用力肺活量(FVC)为(3.59±0.77)L,高于治疗前[(3.47±0.76)L,P=0.036],而治疗前后FEV1/FVC和FVC占预计值的比例(FVC%pred)差异均无统计学意义(P=0.084、0.344)。一氧化碳弥散量(DLCO)占预计值的比例(DLCO%pred)由治疗前的83.61%±13.10%下降到治疗后的78.69%±13.85%(P=0.023);DLCO%pred下降组与未下降组间术后并发症的发生率差异无统计学意义(3/18比0/6;P=0.546)。结论新辅助免疫治疗能够增加MPR和pCR率;明显提高FEV1及FEV1%pred,但也导致DLCO%pred下降;新辅助免疫治疗并没有增加术后并发症的发生率。

Objective To explore the effect of neoadjuvant immunotherapy on pulmonary function and the efficacy in patients with resectable non-small cell lung cancer.Methods Data of 30 patients with non-small cell lung cancer(NSCLC)who received neoadjuvant immunotherapy before surgery in the Chest Hospital of Shanghai Jiaotong University from March 2018 to September 2021 were retrospectively collect.The efficacy and safety of neoadjuvant immunotherapy in the perioperative period and changes in pulmonary function of patients before and after neoadjuvant treatment were valuated.Results The patients were all-male with age of(61±8)years old,The major pathological response(MPR)rate of patients receiving neoadjuvant immunotherapy was 43%(13 cases),the pathologic complete response(pCR)rate was 37%(11 cases),disease control rate(DCR)was 97%(29 cases),objective response rate(ORR)was 67%(20 cases).The forced expiratory volume in one second(FEV1)after treatment was(2.59±0.63)L,and the ratio of FEV1 to the predicted value(FEV1%pred)was 85.27%±15.86%,which were significantly higher than those before treatment[(2.48±0.59)L,81.73%±15.94%,respectively](P=0.013,0.022,respectively).Forced vital capacity(FVC)after treatment was(3.59±0.77)L,which was also significantly higher than before[(3.47±0.76)L,P=0.036];while there were no statistical difference in FEV1/FVC and FVC accounted for the proportion of predicted values(FVC%pred)between before and after treatment(P=0.084,0.344,respectively).The ratio of carbon monoxide dispersion(DLCO)to the predicted value(DLCO%pred)decreased from 83.61%±13.10%to 78.69%±13.85%after treatment(P=0.023).There was no significant difference in the incidence of postoperative complications between the DLCO%pred decreased group and the non-decreased group(3/18 vs 0/6;P=0.546).Conclusions Neoadjuvant immunotherapy can increase the rate of MPR and PCR,significantly increase FEV1 and FEV1%pred,but also lead to a decrease in DLCO%pred;neoadjuvant immunotherapy does not increase the incidence of postoperative complications.