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

作　　者：徐源[1] 梁乃新[1] 刘洪生[1] Xu Yuan;Liang Naixin;Liu Hongsheng(Department of Thoracic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院胸外科,北京100730

出　　处：《首都医科大学学报》2024年第4期649-653,共5页Journal of Capital Medical University

基　　金：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)

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。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.

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 

分 类 号：R734.2[医药卫生—肿瘤]