初始不可切除期Ⅲ非小细胞肺癌诱导免疫化疗后的转化手术：一项多中心研究。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer Pub Date : 2024-11-28 DOI:10.1016/j.cllc.2024.11.005

Mingliang Wang , Xiaojun Wang , Ran Yang , Mingfei Geng , Songlin Zhang , Zebo Yang , Quanfu Huang , Sihua Wang , Shuangbing Xu , Ke Jiang , Yongde Liao

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引用次数: 0

摘要

背景：免疫化疗在可切除的非小细胞肺癌（NSCLC）患者中显示出显著的抗肿瘤作用。此外，对于最初诊断为不可切除的III期非小细胞肺癌患者，诱导免疫化疗可能会降低肿瘤分期，使其转化为可切除的疾病，从而通过R0切除。本研究旨在评估不可切除的III期非小细胞肺癌诱导免疫化疗后转化手术的有效性和安全性。患者和方法：回顾性分析2019年3月至2022年4月在中国三家机构接受诱导免疫化疗的113例不可切除期Ⅲ非小细胞肺癌患者。在2-4个周期的免疫化疗后，一个多学科团队（MDT）重新评估了每个病例的肿瘤反应和可切除性。手术切除的患者达到肿瘤分期降低到可切除的疾病。分析患者的手术及肿瘤预后。结果：113例接受免疫化疗的患者中，79例（69.9%）达到可切除状态并接受手术治疗。手术包括肺叶切除术55例（69.6%），袖状肺叶切除术14例（17.7%），胆叶切除术6例（7.6%），全肺切除术4例（5.1%），R0切除率为98.7%（78/79）。虽然17例患者（21.5%）出现术后并发症，但未记录手术相关的30天或90天死亡率。病理反应方面，主要病理反应44例（55.7%），完全病理反应25例（31.6%）。中位无进展生存期（PFS）和总生存期（OS）未达到。12个月和24个月的PFS分别为82.3%和72.2%，OS分别为94.9%和84.5%。结论：免疫化疗后的转换手术是可行且安全的，对于无法切除的III期NSCLC患者具有良好的病理反应和良好的生存结果。

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Conversion Surgery for Initially Unresectable Stage Ⅲ Nonsmall Cell Lung Cancer After Induction Treatment of Immunochemotherapy: A Multicenter Study

Background

Immuno-chemotherapy has demonstrated significant anti-tumor effects in patients with resectable nonsmall cell lung cancer (NSCLC). Additionally, for patients initially diagnosed with unresectable stage III NSCLC, induction immuno-chemotherapy may achieve tumor downstaging, enabling conversion to resectable disease allowing for by R0 resection. This study aimed to assess the effectiveness and safety of induction immuno-chemotherapy followed by conversion surgery in unresectable stage III NSCLC.

Patients and Methods

A total of 113 patients with unresectable stage Ⅲ NSCLC who received induction immuno-chemotherapy at three institutions in China from March 2019 to April 2022 were retrospectively identified. After 2-4 cycles of immuno-chemotherapy, a multisiciplinary team (MDT) reassessed the tumor response and resectability in each case. Surgical resection was performed for patients who achieved tumor downstaging to resectable disease. Surgical and oncological outcomes of the patients were analyzed.

Results

Of the 113 patients treated with immuno-chemotherapy, 79 (69.9%) achieved conversion to resectable state and underwent surgery. Surgical procedures included lobectomy in 55 (69.6%) patients, sleeve lobectomy in 14 (17.7%) patients, bilobectomy in 6 (7.6%) patients, and pneumonectomy in 4 (5.1%) patients, achieving an R0 resection rate of 98.7% (78/79). No surgical-related 30-day or 90-day mortalities were recorded, although 17 patients (21.5%) experienced postoperative complications. In terms of pathological response, 44 (55.7%) patients achieved major pathologic response and 25 (31.6%) patients achieved complete pathologic response. Median progression-free survival (PFS) and overall survival (OS) was not reached. The 12- and 24-month PFS rates were 82.3% and 72.2%, while OS rates were 94.9% and 84.5%, respectively.

Conclusion

Conversion surgery following immuno-chemotherapy is feasible and safe, yielding promising pathological responses and favorable survival outcomes for patients with unresectable stage III NSCLC.

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来源期刊

Clinical lung cancer 医学-肿瘤学

CiteScore

7.00

自引率

2.80%

发文量

159

审稿时长

24 days

期刊介绍： Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.