2022 年10 期 第30 卷
肺癌专题研究![查看全文 查看全文](/Areas/201911120101/Content/img/icon_html.png)
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术前免疫检查点抑制剂联合化疗治疗可切除Ⅲ期非小细胞肺癌的疗效及患者近期预后的影响因素分析
Efficacy of Preoperative Immune Checkpoint Inhibitor Combined with Chemotherapy in the Treatment of ResectableStage Ⅲ Non-Small Cell Lung Cancer and Influencing Factors of Short-term Prognosis of Patients
作者:杨森,谢颂平,龙杏林,张文涵,黄杰
- 单位:
- 430060湖北省武汉市,武汉大学人民医院胸外科
- 单位(英文):
- Department of Chest Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
- 关键词:
- 癌,非小细胞肺;免疫检查点抑制剂;抗肿瘤联合化疗方案;新辅助免疫治疗;治疗结果;预后;影响因素分析
- 关键词(英文):
- Carcinoma, non-small-cell Lung; Immune checkpoint inhibitors; Antineoplastic combined chemotherapyprotocols; Neoadjuvant immunotherapy; Treatment outcome; Prognosis; Root cause analysis
- 中图分类号:
- R 734.2
- DOI:
- 10.12114/j.issn.1008-5971.2022.00.226
- 基金项目:
摘要:
目的 分析免疫检查点抑制剂(ICI)联合化疗治疗可切除Ⅲ期非小细胞肺癌(NSCLC)的疗效,并探讨患者近期预后的影响因素。方法 回顾性收集2019年1月至2021年5月武汉大学人民医院收治的可切除Ⅲ期NSCLC患者45例为研究对象。患者均经ICI联合含铂双药化疗方案治疗后进行手术治疗。记录患者临床疗效、毒副作用发生情况、手术情况、术后住院时间、术后并发症发生情况、随访情况。以主要病理缓解(MPR)为可切除Ⅲ期NSCLC患者近期预后评定指标,并根据其将患者分为MPR组与非MPR组;采用多因素Logistic回归分析探讨可切除Ⅲ期NSCLC患者近期预后影响因素。结果 45例患者完成ICI联合化疗1~4个周期。完全缓解(CR)4例,部分缓解(PR)23例,病情稳定(SD)14例,疾病进展(PD)4例,客观缓解率(ORR)为60.0%,疾病控制率(DCR)为91.1%。ICI联合化疗过程中出现不同程度的毒副作用,其中出现反应性皮肤毛细血管增生症/皮疹最多,达31例(68.9%)。完成手术治疗40例,手术切除率为88.9%。术后病理结果显示达到MPR 22例(55.0%);MPR组与非MPR组美国东部肿瘤协作组(ECOG)评分、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、乳酸脱氢酶(LDH)和程序性死亡配体1(PD-L1)表达水平比较,差异有统计学意义(P <0.05)。多因素Logistic回归分析结果显示,ECOG评分〔OR =8.146,95%CI (2.842,23.344)〕、NLR〔OR =8.146,95%CI (2.842,23.344)〕是可切除Ⅲ期NSCLC患者近期预后的影响因素(P <0.05)。结论 ICI联合化疗治疗可切除Ⅲ期NSCLC患者疗效确切,具有一定安全性,ECOG评分、NLR是可切除Ⅲ期NSCLC患者近期预后的独立影响因素。
英文摘要:
Objective To analyze the efficacy of preoperative immune checkpoint inhibitor (ICI) combined withchemotherapy in the treatment of resectable stage Ⅲ non-small cell lung cancer (NSCLC) , and to explore the influencing factorsof short-term prognosis of patients. Methods A total of 45 patients with resectable stage Ⅲ NSCLC in Renmin Hospital ofWuhan University from January 2019 to May 2021 were retrospectively selected as study subjects. The patients were treated withICI combined with platinum-containing dual-drug chemotherapy and then given surgical treatment. The clinical efficacy, sideeffects, operation postorperative hospital stay, postoperative complications and follow-up conditions of the patients were recorded.The main pathological remission (MPR) was used as an index to evaluate the short-term prognosis of patients with resectable stageⅢ NSCLC. And patients were divided into MPR group and non-MPR group according to MPR. Multivariate Logistic regression analysis was used to explore the influencing factors of short-term prognosis of patients with resectable stage Ⅲ NSCLC. Results Forty-five patients completed ICI combined with chemotherapy for 1-4 cycles. Complete remission (CR) 4 cases, partial remission(PR) 23 cases, stable disease (SD) 14 cases, disease progression (PD) 4 cases, objective remission rate (ORR) was 60.0%, anddisease control rate (DCR) was 91.1%. In the process of ICI combined with chemotherapy, there were different degrees of toxicand side effects, among which reactive cutaneous capillary hyperplasia/rash was the most common, reaching 31 cases (68.9%) .Surgical treatment was completed in 40 cases, and the surgical resection rate was 88.9%. Postoperative pathological resultsshowed that MPR was achieved in 22 cases (55.0%) . There were significant differences in the scores of Eastern American CancerCollaborative Group (ECOG) , the ratio of neutrophils to lymphocytes (NLR) , the ratio of platelets to lymphocytes (PLR) , lactatedehydrogenase (LDH) and the expression levels of programmed death factor ligand 1 (PD-L1) between MPR group and non-MPRgroup (P < 0.05) . Multivariate Logistic regression analysis showed that ECOG score [OR =8.146, 95%CI (2.842, 23.344) ] andNLR [OR =8.146, 95%CI (2.842, 23.344) ] were the influencing factors for the short-term prognosis of patients with resectablestage Ⅲ NSCLC (P < 0.05) . Conclusion ICI combined with chemotherapy is effective and safe in the treatment of patientswith resectable stage Ⅲ NSCLC. ECOG score and NLR are the influencing factors for the short-term prognosis of patients withresectable stage Ⅲ NSCLC.
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