肺癌围手术期免疫治疗的进展、争议与共识  

Advances,controversies,and consensus in perioperative immunotherapy for lung cancer

作　　者：金莉 周彩存 Li Jin;Caicun Zhou(Department of Oncology,Tongji University Affiliated Shanghai East Hospital,Shanghai 200123,China;Institute of Oncology,Tongji University School of Medicine,Shanghai 200123,China)

机构地区：[1]同济大学附属东方医院附属肿瘤科,上海市200123 [2]同济大学医学院肿瘤研究所

出　　处：《中国肿瘤临床》2024年第16期817-821,共5页Chinese Journal of Clinical Oncology

基　　金：国自然重点专项基金项目(编号:82141101)资助。

摘　　要：近年来,非小细胞肺癌(non-small cell lung cancer,NSCLC)围手术期免疫治疗取得了显著进展。多项Ⅲ期的国际临床研究(如CheckMate-816、IMpower010和KEYNOTE-091等)表明,新辅助免疫治疗和辅助免疫治疗可以显著改善Ⅱ~Ⅲ期NSCLC患者的病理缓解率、无事件生存期(event-free survival,EFS)和无病生存期(disease-free survival,DFS),并获得了各国监管部门的批准。进一步的研究如KEYNOTE-671、AEGEAN和CheckMate-77T等,则验证了“新辅助+辅助”免疫治疗模式的潜在优势,并显著降低了特定人群的术后复发风险。此外,PD-L1表达、MRD状态及ctDNA监测作为疗效预测标志物正在研究中,以优化个体化治疗策略。然而,围手术期免疫治疗在治疗模式选择、最佳周期及针对驱动基因阳性患者的应用上仍存在争议。未来的研究将继续探讨免疫治疗在不同亚群患者中的疗效,以实现最大化的临床获益,同时降低治疗带来的毒性风险。In recent years,perioperative immunotherapy for non-small cell lung cancer(NSCLC)has made significant progress.Several international phaseⅢclinical trials(such as CheckMate-816,IMpower010 and KEYNOTE-091)have demonstrated that neoadjuvant and adjuvant immunotherapy can significantly improve pathological response rates,event-free survival(EFS),and disease-free survival(DFS)in stageⅡ-ⅢNSCLC patients,leading to regulatory approvals worldwide.Further studies,including KEYNOTE-671,AEGEAN,and CheckMate-77T,have validated the potential advantages of the"neoadjuvant+adjuvant"immunotherapy approach,significantly reducing the risk of postoperative recurrence in certain populations.Additionally,biomarkers such as PD-L1 expression,minimal residual disease(MRD)status,and ctDNA monitoring are being investigated as predictive indicators to optimize individualized treatment strategies.However,there are still controversies regarding the choice of perioperative immunotherapy modes,the optimal treatment cycle,and the application in patients with driver gene mutations.Future research will continue to explore the efficacy of immunotherapy in different patient subgroups to maximize clinical benefits while minimizing the toxicity risks associated with treatment.

关 键 词：非小细胞肺癌 围手术期免疫治疗 新辅助与辅助治疗 

分 类 号：R734.2[医药卫生—肿瘤]