初始不可切除IIIB期非小细胞肺癌免疫联合化疗后的根治性微创手术

Radical Minimally Invasive Surgery After Immuno-chemotherapy in Initially-unresectable Stage ⅢB Non-small cell Lung Cancer

二维码有效期 120s

摘要背景新辅助免疫治疗在局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的应用仍存在争议.因此,本研究旨在报道通过免疫联合化疗将初始不可切除cIIIB期NSCLC患者转化为根治性微创手术的系列病例,评估手术效果和术后的生存获益.方法回顾性分析2018年5月-2020年8月期间接受程序性细胞死亡受体1(programmed cell death-1,PD-1)抑制剂联合含铂双药化疗的51例cIIIB期NSCLC患者.收集入组患者手术相关数据和肿瘤相关数据.结果31例患者最终接受手术治疗,其中23例(74.2％)患者行肺叶切除术,1例(3.2％)患者行全肺切除术,5例(16.1％)患者行袖状肺叶切除术,2例(6.5％)患者行双肺叶切除术.中位手术时间为205 min(范围100-520),平均失血量为185 mL(范围10-1100).15例患者出现致密粘连或纤维化.术后平均住院时间为6 d(范围3-13).无手术相关死亡,仅5例(16.1％)患者发生术后并发症(无3级以上并发症).10例(32.3％)患者达到主要病理缓解,22/31例(71.0％)患者出现纵隔病变降期.中位随访15.4个月,31例手术患者的中位无进展生存期/无病生存期(progression-free survival/disease-free survival,PFS/DFS)相对于未进行手术的无缓解或缓解的患者(分别为27.5个月vs 4.7个月vs 16.7个月)更长.结论初始不可切除的IIIB期NSCLC接受免疫联合化疗治疗后行根治性手术相对安全,手术相关死亡率和并发症发病率较低,与未手术患者相比DFS/PFS更长.

作者 Hongsheng DENG ^[1] Jun LIU ^[1] Xiuyu CAI ^[2] Jiawei CHEN ^[1] Gaetano ROCCO ^[3] Rene'Horsleben PETERSEN ^[4] Alessandro BRUNELLI ^[5] Calvin S.H.NG ^[6] Thomas A. D'AMICO ^[7] Wenhua LIANG ^[1] Jianxing HE ^[1] 雷杰 ^[8] 学术成果认领

作者单位 Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China ^[1] Department of General Internal Medicine, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China ^[2] Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY ^[3] Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark ^[4] Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK ^[5] Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong SAR, China ^[6] Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC ^[7] 空军军医大学第二附属医院胸腔外科,西安 710000 ^[8]

关键词免疫联合化疗新辅助治疗初始不可切除非小细胞肺癌手术切除

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DOI 10.3779/j.issn.1009-3419.2022.103.04

发布时间 2022-12-07