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

Units：

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

Keywords：

Carcinoma, non-small-cell Lung; Immune checkpoint inhibitors; Antineoplastic combined chemotherapyprotocols; Neoadjuvant immunotherapy; Treatment outcome; Prognosis; Root cause analysis

CLC：

R 734.2

DOI：

10.12114/j.issn.1008-5971.2022.00.226

Funds：

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。

Abstract：

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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