新辅助免疫联合化疗治疗可切除非小细胞肺癌初步经验

Preliminary experience of neoadjuvant immunochemotherapy in resectable non-small cell lung cancer

目的探索新辅助免疫联合化疗治疗可切除非小细胞肺癌安全性及有效性分析。方法回顾性分析我院胸外科2019年1月至2021年9月接受新辅助治疗后联合外科手术治疗非小细胞肺癌的连续患者资料,比较新辅助化免组和新辅助化疗组两组间的安全性、有效性以及手术和术后情况。结果纳入44例患者,其中新辅助化免组19例,新辅助化疗组25例;鳞癌占所有患者的65.91%;中央型肺癌39例(88.64%);新辅助治疗结束至手术间隔时间平均34天,其中免疫联合化疗组(33.74±10.66)天,化疗组(33.88±11.9)天,组间比较差异无统计学意义。所有患者均未发生3级以上不良反应。新辅助化免组获得整体缓解(overall response,OR)13例(63.16%),新辅助化疗组获得OR 11例(44.00%),组间比较差异无统计学意义。新辅助化免组达到降期9例(47.37%),新辅助化疗组降期8例(32.00%),组间比较差异无统计学意义。新辅助化免组7例(36.84%)患者达到病理完全缓解(pathological complete response,pCR),新辅助化疗组无达到pCR的患者,组间差异有统计学意义(P=0.001);新辅助化免组4例(21.05%)患者达到主要病理缓解(main pathological remission,mPR),新辅助化疗组6例(24.00%)患者达到mPR,差异无统计学意义(P=0.817)。结论新辅助免疫治疗联合化疗安全性满意;与新辅助化疗相比,新辅助免疫治疗联合化疗并未增加术前3级以上不良反应、延长手术前等待时间;新辅助化免在pCR的优势明显,为肿瘤的治愈提供了可能。

Objective The study aimed was to explore the safety and efficacy of neoadjuvant immunochemotherapy for non-small cell lung cancer(NSCLC).Methods We retrospectively collected data of all patients who received neoadjuvant immunochemotherapy and chemotherapy for NSCLC followed by surgery in our unit between January 2019 to September 2021.Results Forty-four patients were diagnosed with NSCLC in a stageⅠ(2 cases),ⅡA(7 cases),ⅡB(11 cases),ⅢA(15 cases),ⅢB(1 case).The average age was 63 years old(range 44-71 years old).Squamous cell carcinoma accounted for 65.91%of all patients.Central lung cancer accounted for the vast majority,with 39 patients(88.64%).There were 19 cases in the neoadjuvant immunochemotherapy group and 25 cases in the neoadjuvant chemotherapy group;the average interval between the end of neoadjuvant therapy and the day of operation was 34 days,including(33.74±10.66)days in the immunochemotherapy group and(33.88±11.9)days in the chemotherapy group,and there was no significant difference between the two groups.No grade 3 or more adverse events occurred in all patients.There were 13 cases(63.16%)reached PR(partial response)+CR(complete response)according to the Response Evaluation Criteria in Solid Tumors(RECIST v.1.1)in the neoadjuvant immunity group and 11 cases(44.00%)in the neoadjuvant chemotherapy group.There was no significant difference between the two groups.In the neoadjuvant immunochemotherapy group,9 cases(47.37%)achieved down-staging,In the neoadjuvant chemotherapy group,8 cases(32.00%)achieved down-staging,there was no significant difference between the two groups.Seven patients(36.84%)in neoadjuvant immunochemotherapy group showed pCR(pathologic complete remission),but there were no patients who reached pCR in the neoadjuvant chemotherapy group.,the difference was statistically significant(P=0.001).Four patients(21.05%)in the neoadjuvant immunochemotherapy group reached mPR(major pathologic response),6 patients(24.00%)in the neoadjuvant chemotherapy group reached mPR,and the difference was no statistically significant(P=0.817).Conclusion The safety of neoadjuvant immunochemotherapy was satisfactory;Compared with neoadjuvant chemotherapy,neoadjuvant immunochemotherapy did not increase the preoperative grade 3 adverse events and prolong the waiting time before operation;neoadjuvant immunochemotherapy had obvious advantages in pCR,which provided the possibility for the cure of tumor.