Real-World Effectiveness and Prognostic Factors Analysis of Stages I-III Non-Small Cell Lung Cancer Following Neoadjuvant Chemo-Immunotherapy or Neoadjuvant Chemotherapy.

Zuo Liu, Zhaoming Gao, Mengzhe Zhang, Xiaofei Wang, Jialin Gong, Shuai Jiang, Zhenfa Zhang
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引用次数: 6

Abstract

Purpose: Immune checkpoint inhibitors (ICIs) have been successfully used in many clinical trials related to immunotherapy. This study aimed to investigate the clinical efficacy of ICIs and prognostic factors in patients with resectable non-small cell lung cancer (NSCLC) following neoadjuvant therapy in the real world.

Methods: A total of 170 consecutive patients were finally selected and divided into two groups: the preoperative chemotherapy group (n = 91) and the chemo-immunotherapy group (n = 79). The primary endpoint was disease-free survival (DFS). The secondary endpoints were pathological response, clinical response, pathological nodal disease, and ability of multivariate Cox regression analysis to predict survival. Survival was estimated using Kaplan-Meier method and compared using log-rank test.

Results: There was a statistically significant difference in DFS between the two groups (log-rank test, P = 0.019). Multivariate Cox regression analysis showed that maximum tumor diameter (P = 0.016), higher lymph node stage (ypN1, P = 0.016; ypN2, P <0.001), and major pathological response not achieved (non-major pathological response [MPR], P = 0.011) were independent prognostic factors for worse DFS.

Conclusion: Neoadjuvant chemo-immunotherapy yields better effects in pathological and clinical response than chemotherapy alone, which is also associated with longer DFS in the treatment of locally advanced NSCLC. Moreover, a larger tumor specimen diameter, higher ypN staging, and non-MPR after neoadjuvant therapy were associated with worse prognosis.

Abstract Image

Abstract Image

新辅助化疗-免疫治疗或新辅助化疗后I-III期非小细胞肺癌的实际疗效和预后因素分析
目的:免疫检查点抑制剂(ICIs)已成功应用于许多与免疫治疗相关的临床试验。本研究旨在探讨现实世界中可切除非小细胞肺癌(NSCLC)患者在新辅助治疗后使用ICIs的临床疗效及影响预后的因素。方法:最终选取连续170例患者,分为术前化疗组(91例)和化疗免疫治疗组(79例)。主要终点为无病生存期(DFS)。次要终点是病理反应、临床反应、病理淋巴结疾病和多变量Cox回归分析预测生存的能力。生存率采用Kaplan-Meier法估计,log-rank检验比较。结果:两组患者DFS比较,差异有统计学意义(log-rank检验,P = 0.019)。多因素Cox回归分析显示,最大肿瘤直径(P = 0.016)、较高淋巴结分期(ypN1, P = 0.016;结论:新辅助化疗-免疫治疗在病理和临床反应方面均优于单纯化疗,且在局部晚期NSCLC治疗中,新辅助化疗-免疫治疗可延长DFS。此外,新辅助治疗后肿瘤标本直径越大、ypN分期越高、非mpr越差,预后越差。
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