非小细胞肺癌新辅助免疫治疗的预后影响因素:病理淋巴结转移程度与原发灶缓解程度

doi:10.3969/j.issn.1006-7795.2024.04.014

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (4): 649-653.doi: 10.3969/j.issn.1006-7795.2024.04.014

• 肺癌新辅助免疫治疗临床研究 • 上一篇下一篇

非小细胞肺癌新辅助免疫治疗的预后影响因素:病理淋巴结转移程度与原发灶缓解程度

徐源, 梁乃新^*#, 刘洪生^*#

中国医学科学院北京协和医院胸外科，北京 100730

收稿日期:2024-04-22 出版日期:2024-08-21 发布日期:2024-07-08
通讯作者: 梁乃新, 刘洪生 E-mail:pumchnelson@163.com, hongshengliu16@163.com
基金资助:
中央高水平医院临床科研基金项目（2022-PUMCH-A-188，2022-PUMCH-B-012），希思科-默沙东肿瘤研究基金项目（CSCO-Y-MSDPU2021-0190，CSCO-Y-MSD2020-0270）。

Prognostic factors in neoadjuvant immunotherapy for non-small cell lung cancer：pathologic lymph node metastasis and primary tumor response

Xu Yuan, Liang Naixin^*#, Liu Hongsheng^*#

Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences， Beijing 100730, China

Received:2024-04-22 Online:2024-08-21 Published:2024-07-08
Supported by:
This study was supported by National High Level Hospital clinical Research Funding (2022-PUMCH-A-188，2022-PUMCH-B-012)，Hiscox-Merck Oncology Research Fund Project (CSCO-Y-MSDPU2021-0190，CSCO-Y-MSD2020-0270)

摘要/Abstract

摘要： 目的探讨新辅助免疫治疗后病理淋巴结转移情况及原发灶缓解程度对非小细胞肺癌（non-small cell lung cancer, NSCLC）患者预后的影响。方法回顾性分析40例接受新辅助免疫治疗后行手术切除的NSCLC患者的临床病理资料。评估病理淋巴结分期（N1/N2）和原发灶缓解程度［完全缓解(pathological complete response，pCR)/主要缓解(major pathological response，MPR)/非客观缓解(non-objective response，non-OR)］与无进展生存期（progression-free survival, PFS）的关系，并构建预后风险分层模型。结果病理淋巴结分期和原发灶缓解程度单独考虑时，与PFS无显著相关性，且两者无显著交互作用。对于N1患者,pCR/MPR的PFS优于non-OR (P =0.038)；对于N2患者，原发灶缓解程度与PFS无显著相关性。将患者分为低危组(N1+pCR/MPR)和高危组 (N1+non-OR/N2)，两组PFS差异显著 (P =0.003)。结论新辅助免疫治疗后，病理淋巴结转移程度和原发灶缓解程度是NSCLC预后的关键影响因素。基于两者的预后风险分层模型有助于指导个体化治疗决策，但仍需前瞻性研究验证。

关键词: 非小细胞肺癌, 新辅助免疫治疗, 病理淋巴结转移, 原发灶缓解, 预后

Abstract: Objective To investigate the prognostic impact of pathologic lymph node metastasis and primary tumor response after neoadjuvant immunotherapy in patients with non-small cell lung cancer (NSCLC). Methods Clinicopathological data of 40 NSCLC patients who underwent surgical resection after neoadjuvant immunotherapy were retrospectively analyzed. The relationships of pathologic nodal stage (N1/N2) and primary tumor response ［pathological complete response (pCR)/major pathological response (MPR)/non-objective response (non-OR)］with progression-free survival (PFS) were evaluated, and a prognostic risk stratification model was established. Results Pathologic nodal stage and primary tumor response were not significantly associated with PFS when considered separately. However, their interaction had a significant impact on prognosis： for N1 patients, the ones with pCR/MPR had better PFS than those with non-OR (P =0.038); for N2 patients, primary tumor response was not significantly associated with PFS. Based on the interaction, patients were stratified into low-risk (N1+pCR/MPR) and high-risk (N1+non-OR/N2) groups, with significant differences in PFS (P =0.003). Conclusions The interaction between pathologic lymph node metastasis and primary tumor response is a key prognostic factor in NSCLC after neoadjuvant immunotherapy. The prognostic risk stratification model based on their interaction may help guide individualized treatment decisions, but prospective validation is needed.

Key words: non-small cell lung cancer, neoadjuvant immunotherapy, pathologic lymph node metastasis, primary tumor response, prognosis

中图分类号:

R734.2

徐源, 梁乃新, 刘洪生. 非小细胞肺癌新辅助免疫治疗的预后影响因素:病理淋巴结转移程度与原发灶缓解程度[J]. 首都医科大学学报, 2024, 45(4): 649-653.

Xu Yuan, Liang Naixin, Liu Hongsheng. Prognostic factors in neoadjuvant immunotherapy for non-small cell lung cancer：pathologic lymph node metastasis and primary tumor response[J]. Journal of Capital Medical University, 2024, 45(4): 649-653.

参考文献

［1］ Siegel R L, Miller K D, Statistics J A C, et al. Cancer statistics, 2020［J］. CA Cancer J Clin, 2020, 70(1): 7-30.
［2］ Blumenthal G M, Bunn P A J, Chaft J E, et al. Current status and future perspectives on neoadjuvant therapy in lung cancer［J］. J Thorac Oncol, 2018, 13(12): 1818-1831.
［3］ Forde P M, Chaft J E, Smith K N, et al. Neoadjuvant PD-1 blockade in resectable lung cancer［J］. N Engl J Med, 2018, 378(21): 1976-1986.
［4］ Cascone T, William W N J, Weissferdt A, et al. Neoadjuvant nivolumab or nivolumab plus ipilimumab in operable non-small cell lung cancer: the phase 2 randomized NEOSTAR trial［J］. Nat Med, 2021, 27(3): 504-514.
［5］ Hellmann M D, Chaft J E, William W N J, et al. Pathological response after neoadjuvant chemotherapy in resectable non-small-cell lung cancers: proposal for the use of major pathological response as a surrogate endpoint［J］. Lancet Oncol, 2014, 15(1): e42-e50.
［6］ Qu Y, Emoto K, Eguchi T K H, et al. Pathologic assessment after neoadjuvant chemotherapy for NSCLC: importance and implications of distinguishing adenocarcinoma from squamous cell carcinoma［J］. J Thorac Oncol, 2019, 14(3): 482-493.
［7］ Ren S J, Wang C G, Shen J F, et al. Neoadjuvant immunotherapy with resectable non-small cell lung cancer: recent advances and future challenges［J］. J Thorac Dis, 2020, 12(4): 1615-1620.
［8］ Zhang J J, Ji Z C, Caushi J X, et al. Compartmental analysis of t-cell clonal dynamics as a function of pathologic response to neoadjuvant PD-1 blockade in resectable Non-Small cell lung cancer［J］. Clin Cancer Res, 2020, 26(6): 1327-1337.
［9］ Bott M J, Yang S C, Park B J, et al. Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non-small cell lung cancer［J］. J Thorac Cardiovasc Surg, 2019, 158(1): 269-276.
［10］ Detterbeck F C, Boffa D J, Kim A W, et al. The eighth edition lung cancer stage classification［J］. Chest, 2017, 151(1): 193-203.
［11］ Zhu J W, Li R, Tiselius E, et al. Immunotherapy (excluding checkpoint inhibitors) for stage I to Ⅲ non-small cell lung cancer treated with surgery or radiotherapy with curative intent［J］. Cochrane Database Syst Rev, 2017, 12(12): CD011300.
［12］ Bott M J, Cools-Lartigue J, Tan K S, et al. Safety and feasibility of lung resection after immunotherapy for metastatic or unresectable tumors［J］. Ann Thorac Surg, 2018, 106(1): 178-183.
［13］ Garon E B, Hellmann M D, Costa E C, et al. Five-year overall survival for patients with advanced non-small-cell lung cancer treated with pembrolizumab: results from the phase I KEYNOTE-001 study［J］. J Clin Oncol, 2019, 37(28): 2518-2527.
［14］ Cottrell T R, Thompson E D, Forde P M, et al. Pathologic features of response to neoadjuvant anti-PD-1 in resected non-small-cell lung carcinoma: a proposal for quantitative immune-related pathologic response criteria (irPRC)［J］. Ann Oncol, 2018, 29(8): 1853-1860.
［15］ Stein J E, Lipson E J, Cottrell T R, et al. Pan-tumor pathologic scoring of response to PD-(L)1 blockade［J］. Clin Cancer Res, 2020, 26(3): 545-551.

[1]	吴朝真, 郑华, 盛舒言, 张权, 张卉, 李杰, 吕嘉林, 钱哲, 王守正, 李曦, 胡瑛. 新辅助免疫联合化疗在非小细胞肺癌中的初步疗效观察[J]. 首都医科大学学报, 2024, 45(4): 642-648.
[2]	王居巳, 宋伟安, 狄守印, 刘军强, 范博士, 周少华, 岳彩迎, 赵嘉华, 陈思禹, 龚太乾. 新辅助化疗联合免疫抑制剂对Ⅲ期非小细胞肺癌治疗有效性分析[J]. 首都医科大学学报, 2024, 45(4): 660-665.
[3]	郝卓鸿, 云铎, 张颖, 李卉惠, 林海珊, 崔永, 赵磊. 非小细胞肺癌围手术期免疫治疗研究进展———新辅助免疫治疗进展[J]. 首都医科大学学报, 2024, 45(4): 666-677.
[4]	白羽, 李雪清, 郭益群, 杨春霞, 谷丽. 肺毛霉菌病临床特征及预后分析[J]. 首都医科大学学报, 2024, 45(4): 706-714.
[5]	王润锦, 叶小波, 张玉冬, 朱光艺, 杨坤, 牛亦农. 不同侵袭模式对T3a肾细胞癌患者预后的影响[J]. 首都医科大学学报, 2023, 44(3): 439-448.
[6]	郭继红, 朱宁, 葛洋, 安广宇. 晚期胰腺癌患者的临床特征及预后分析[J]. 首都医科大学学报, 2023, 44(3): 501-506.
[7]	胡舒缘, 张开元, 谷亚钦, 李京凯, 周陈, 吉训明, 段建钢. 糖皮质激素联合抗凝在急性/亚急性重症颅内静脉血栓治疗中的探索[J]. 首都医科大学学报, 2023, 44(2): 280-288.

非小细胞肺癌新辅助免疫治疗的预后影响因素:病理淋巴结转移程度与原发灶缓解程度

Prognostic factors in neoadjuvant immunotherapy for non-small cell lung cancer：pathologic lymph node metastasis and primary tumor response

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 7

编辑推荐

Metrics

本文评价