真实世界回顾性分析免疫新辅助治疗在肺癌中的应用价值

Real-world retrospective analysis of the value of neoadjuvant chemoimmunotherapy combined with surgery therapy in lung cancer

目的探索免疫联合化疗的新辅助治疗在可切除非小细胞肺癌(non-small cell lung cancer,NSCLC)中的应用价值。方法纳入2020年1月1日至2022年6月1日,入住中国科学技术大学附属第一医院,经多学科会诊(Multi-Disciplinary Treatment,MDT)拟行免疫联合化疗新辅助治疗的ⅡA-ⅢB期患者33例(分为观察组),以及选取同时间段行化疗新辅助的患者25例(分为对照组)。对照组行≥2周期的化学治疗,观察组在对照组基础上加用免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)。比较两组影像学疗效、手术切除率、主要病理缓解(MPR)、完全病理缓解(pCR),以及影响pCR的因素。结果观察组的部分缓解(PR)率以及客观缓解率(ORR)均优于对照组(P<0.05)。观察组pCR率为44.4%,明显优于对照组(P<0.05),差异有统计学意义。单因素分析显示,新辅助治疗方案以及接受治疗的周期与pCR有关,病理类型、年龄、性别、吸烟史、肿瘤分期等与pCR无相关性。结论新辅助免疫联合化疗相比化疗带来了更高的pCR率,同时建议术前接受3周期的新辅助治疗。

Objective To explore the value of neoadjuvant therapy with immune combination chemotherapy in resectable non-small cell lung cancer(NSCLC).Methods 33 patients admitted to the First Hospital of the University of Science and Technology of China from January 1,2020 to June 1,2022,who received≥2cycles neoadjuvant chemo-immunotherapy designed by Multi-Disciplinary Treatment(MDT),were taken as the observation group,and another 25 patients who were selected to received neoadjuvant chemotherapy during the same period were taken as the control group.The control group was treated with≥2 cycles chemotherapy,while the observation group was treated with Immune Checkpoint Inhibitors(ICIs)in addition to the control group.The imaging efficacy,surgical resection rate,major pathological remission(MPR),complete pathological remission(PCR),and factors affecting PCR were compared between the two groups.Results The partial remission(PR)rate as well as the objective remission rate(ORR)were better in the observation group than in the control group(P<0.05).The PCR rate of the observation group was 44.4%,which was significantly better than that of the control group(P<0.05).Univariate analysis showed that neoadjuvant treatment regimen,and the period of receiving treatment were related to PCR,while pathological type,age,gender,smoking history,and tumor stage were not correlated with PCR.Conclusion Neoadjuvant chemo-immunotherapy results in a higher pCR rate compared with chemotherapy,and it is also recommended to receive 3 cycles of neoadjuvant therapy before surgery.