Sleeve lobectomy versus lobectomy after neoadjuvant chemo-immunotherapy for non-small cell lung cancer invading the lobar bronchial orifice: a multicenter retrospective cohort study.

IF 4 2区 医学 Q2 ONCOLOGY
Translational lung cancer research Pub Date : 2025-02-28 Epub Date: 2025-02-25 DOI:10.21037/tlcr-24-925
Tianyue Ma, Jun Yi, Yong Ge, Haitang Yang, Jiayi Wang, Shuyuan Li, Ran Ma, Guodong Zhang, Hao Peng, Pingping Song, Feng Yao, Hao Zhang
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引用次数: 0

Abstract

Background: For non-small cell lung cancer (NSCLC) invading lobar bronchial orifice, sleeve lobectomy is the preferred surgical option. Neoadjuvant chemo-immunotherapy may allow R0 resection with lobectomy. This study aims to compare the long-term outcome of sleeve lobectomy and lobectomy after neoadjuvant chemo-immunotherapy.

Methods: We retrospectively screened patients undergoing neoadjuvant chemo-immunotherapy followed by lobectomy or sleeve lobectomy for NSCLC invading lobar bronchial orifice from March 2019 and April 2022. Event-free survival (EFS) was compared between sleeve lobectomy and lobectomy groups in the original cohort and the inverse probability of treatment weighting (IPTW) adjusted cohort. Cox regression was conducted for the potential association between surgical type and EFS.

Results: We initially enrolled 248 patients. According to the inclusion criteria, the final analysis included 68 (27.4%) patients: 38 undergoing lobectomy and 30 undergoing sleeve lobectomy. The 2-year EFS was 83.3% versus 60.5% in sleeve and lobotomy groups, respectively [hazard ratio (HR) =0.46, 95% confidence interval (CI): 0.210-1.005; P=0.057]. In Cox regression analysis, improved EFS was associated with pathological complete response (pCR) (HR =0.31, 95% CI: 0.11-0.90; P=0.03) but not surgical types (HR =0.54, 95% CI: 0.22-1.5; P=0.20). In the subgroup analysis including pCR patients (n=31), median EFS was not reached (NR) in either group (P=0.8) before and after IPTW. In the non-pCR subgroup (n=37), median EFS was 21 months (95% CI: 13-NR) in lobectomy group versus not achieved (95% CI: 25-NR) in sleeve lobectomy group (P=0.04) after IPTW.

Conclusions: Lobectomy could be feasible for pCR patients and there is survival advantage with sleeve lobectomy in patients failing to achieve pCR after neoadjuvant chemo-immunotherapy.

侵袭支气管大叶口的非小细胞肺癌的新辅助化疗免疫治疗后袖叶切除术与肺叶切除术:一项多中心回顾性队列研究。
背景:对于侵袭大叶支气管口的非小细胞肺癌(NSCLC),袖状肺叶切除术是首选的手术方法。新辅助化疗免疫治疗可能允许R0切除与肺叶切除术。本研究旨在比较袖状肺叶切除术和新辅助化疗免疫治疗后肺叶切除术的长期预后。方法:回顾性筛选2019年3月至2022年4月接受新辅助化疗-免疫治疗并肺叶切除术或袖状肺叶切除术的非小细胞肺癌侵袭大叶支气管口患者。在原始队列和治疗加权逆概率(IPTW)调整队列中,比较套筒肺叶切除术组和肺叶切除术组的无事件生存率(EFS)。对手术类型与EFS之间的潜在关联进行Cox回归分析。结果:我们最初招募了248名患者。根据纳入标准,最终纳入68例(27.4%)患者,其中38例行肺叶切除术,30例行袖式肺叶切除术。套筒组和额叶切除术组的2年EFS分别为83.3%和60.5%[风险比(HR) =0.46, 95%可信区间(CI): 0.210-1.005;P = 0.057)。在Cox回归分析中,改善的EFS与病理完全缓解(pCR)相关(HR =0.31, 95% CI: 0.11-0.90;P=0.03),但与手术类型无关(HR =0.54, 95% CI: 0.22-1.5;P = 0.20)。在包括pCR患者(n=31)的亚组分析中,两组患者在IPTW前后均未达到中位EFS (NR) (P=0.8)。在非pcr亚组(n=37)中,肺叶切除术组的中位EFS为IPTW后21个月(95% CI: 13-NR),而套筒肺叶切除术组的中位EFS未达到(95% CI: 25-NR) (P=0.04)。结论:对pCR患者行肺叶切除术是可行的,对新辅助化疗免疫治疗后未能达到pCR的患者行套筒肺叶切除术有生存优势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.20
自引率
2.50%
发文量
137
期刊介绍: Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.
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