Ran Ma, Haitang Yang, Yong Ge, Tianyue Ma, Jiayi Wang, Shuyuan Li, Tianci Feng, Shoujie Feng, Cheng Zhang, Teng Sun, Feng Yao, Jun Yi, Hao Zhang, Pingping Song
{"title":"新辅助化疗免疫治疗前后非小细胞肺癌患者淋巴结状态的预后意义：一项多中心回顾性研究","authors":"Ran Ma, Haitang Yang, Yong Ge, Tianyue Ma, Jiayi Wang, Shuyuan Li, Tianci Feng, Shoujie Feng, Cheng Zhang, Teng Sun, Feng Yao, Jun Yi, Hao Zhang, Pingping Song","doi":"10.1016/j.cllc.2025.04.004","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In patients with non-small-cell lung cancer (NSCLC) treated with neoadjuvant chemoimmunotherapy, lymph node (LN) status is classified as ypN0 and ypN+. However, ypN0 includes patients who either had LN metastasis before neoadjuvant therapy (cN+/ypN0) or those who never developed LN metastasis (cN0/ypN0). The prognostic implications of these different LN statuses are not well understood.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients with NSCLC who underwent surgery after neoadjuvant chemoimmunotherapy at 4 centers in China from 2019 to 2022. Patients were grouped by their LN status into ``natural'' N0 (cN0/ypN0), ``downstaged'' N0 (cN+/ypN0), and ypN+ (cN+/ypN+).</p><p><strong>Results: </strong>Out of 527 initially enrolled patients, 186 met the inclusion criteria: 34 (18.3%) had ``natural'' N0, 95 (51.1%) had ``downstaged'' N0, and 57 (30.6%) had ypN+. The median follow-up was 24 months (11-64 months). Disease-free survival (DFS) and overall survival (OS) were significantly lower in ypN+ compared to ``natural'' N0 and ``downstaged'' N0 (DFS: P < .001; OS: P < .001). However, no significant difference in either DFS (P = .695) or OS (P = .814) were observed between ``natural'' N0 and ``downstaged'' N0. Subgroup analysis showed that the MPR/ypN0 group had significantly better DFS compared to the non-MPR/ypN0 (P = .008), MPR/ypN+ (P = .028), and non-MPR/ypN+ groups (P < .001). For OS, MPR/ypN0 group was significantly superior to non-MPR/ypN+ (P < .001) and showed a trend toward better OS than non-MPR/ypN0 (P = .067) and MPR/ypN+ (P = .067). Notably, no significant differences were observed in either DFS (P = .908) or OS (P = .943) between non-MPR/ypN0 and MPR/ypN+ groups. The non-MPR/ypN+ group had the poorest survival outcomes in both DFS and OS.</p><p><strong>Conclusions: </strong>Achieving ypN0 status after neoadjuvant chemoimmunotherapy strongly predicts favorable outcomes in patients with NSCLC, regardless of pretreatment cN status. Combining MPR with LN status effectively differentiates patient prognoses.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic Implications of Lymph Node Status in Non-Small-Cell Lung Cancer Patients Before and After Neoadjuvant Chemoimmunotherapy: A Multicenter Retrospective Study.\",\"authors\":\"Ran Ma, Haitang Yang, Yong Ge, Tianyue Ma, Jiayi Wang, Shuyuan Li, Tianci Feng, Shoujie Feng, Cheng Zhang, Teng Sun, Feng Yao, Jun Yi, Hao Zhang, Pingping Song\",\"doi\":\"10.1016/j.cllc.2025.04.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In patients with non-small-cell lung cancer (NSCLC) treated with neoadjuvant chemoimmunotherapy, lymph node (LN) status is classified as ypN0 and ypN+. However, ypN0 includes patients who either had LN metastasis before neoadjuvant therapy (cN+/ypN0) or those who never developed LN metastasis (cN0/ypN0). The prognostic implications of these different LN statuses are not well understood.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients with NSCLC who underwent surgery after neoadjuvant chemoimmunotherapy at 4 centers in China from 2019 to 2022. Patients were grouped by their LN status into ``natural'' N0 (cN0/ypN0), ``downstaged'' N0 (cN+/ypN0), and ypN+ (cN+/ypN+).</p><p><strong>Results: </strong>Out of 527 initially enrolled patients, 186 met the inclusion criteria: 34 (18.3%) had ``natural'' N0, 95 (51.1%) had ``downstaged'' N0, and 57 (30.6%) had ypN+. The median follow-up was 24 months (11-64 months). Disease-free survival (DFS) and overall survival (OS) were significantly lower in ypN+ compared to ``natural'' N0 and ``downstaged'' N0 (DFS: P < .001; OS: P < .001). However, no significant difference in either DFS (P = .695) or OS (P = .814) were observed between ``natural'' N0 and ``downstaged'' N0. Subgroup analysis showed that the MPR/ypN0 group had significantly better DFS compared to the non-MPR/ypN0 (P = .008), MPR/ypN+ (P = .028), and non-MPR/ypN+ groups (P < .001). For OS, MPR/ypN0 group was significantly superior to non-MPR/ypN+ (P < .001) and showed a trend toward better OS than non-MPR/ypN0 (P = .067) and MPR/ypN+ (P = .067). Notably, no significant differences were observed in either DFS (P = .908) or OS (P = .943) between non-MPR/ypN0 and MPR/ypN+ groups. The non-MPR/ypN+ group had the poorest survival outcomes in both DFS and OS.</p><p><strong>Conclusions: </strong>Achieving ypN0 status after neoadjuvant chemoimmunotherapy strongly predicts favorable outcomes in patients with NSCLC, regardless of pretreatment cN status. Combining MPR with LN status effectively differentiates patient prognoses.</p>\",\"PeriodicalId\":10490,\"journal\":{\"name\":\"Clinical lung cancer\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-04-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical lung cancer\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.cllc.2025.04.004\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical lung cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cllc.2025.04.004","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
Prognostic Implications of Lymph Node Status in Non-Small-Cell Lung Cancer Patients Before and After Neoadjuvant Chemoimmunotherapy: A Multicenter Retrospective Study.
Background: In patients with non-small-cell lung cancer (NSCLC) treated with neoadjuvant chemoimmunotherapy, lymph node (LN) status is classified as ypN0 and ypN+. However, ypN0 includes patients who either had LN metastasis before neoadjuvant therapy (cN+/ypN0) or those who never developed LN metastasis (cN0/ypN0). The prognostic implications of these different LN statuses are not well understood.
Methods: A retrospective analysis was conducted on patients with NSCLC who underwent surgery after neoadjuvant chemoimmunotherapy at 4 centers in China from 2019 to 2022. Patients were grouped by their LN status into ``natural'' N0 (cN0/ypN0), ``downstaged'' N0 (cN+/ypN0), and ypN+ (cN+/ypN+).
Results: Out of 527 initially enrolled patients, 186 met the inclusion criteria: 34 (18.3%) had ``natural'' N0, 95 (51.1%) had ``downstaged'' N0, and 57 (30.6%) had ypN+. The median follow-up was 24 months (11-64 months). Disease-free survival (DFS) and overall survival (OS) were significantly lower in ypN+ compared to ``natural'' N0 and ``downstaged'' N0 (DFS: P < .001; OS: P < .001). However, no significant difference in either DFS (P = .695) or OS (P = .814) were observed between ``natural'' N0 and ``downstaged'' N0. Subgroup analysis showed that the MPR/ypN0 group had significantly better DFS compared to the non-MPR/ypN0 (P = .008), MPR/ypN+ (P = .028), and non-MPR/ypN+ groups (P < .001). For OS, MPR/ypN0 group was significantly superior to non-MPR/ypN+ (P < .001) and showed a trend toward better OS than non-MPR/ypN0 (P = .067) and MPR/ypN+ (P = .067). Notably, no significant differences were observed in either DFS (P = .908) or OS (P = .943) between non-MPR/ypN0 and MPR/ypN+ groups. The non-MPR/ypN+ group had the poorest survival outcomes in both DFS and OS.
Conclusions: Achieving ypN0 status after neoadjuvant chemoimmunotherapy strongly predicts favorable outcomes in patients with NSCLC, regardless of pretreatment cN status. Combining MPR with LN status effectively differentiates patient prognoses.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
