Clinical outcomes associated with neoadjuvant therapy for the treatment of resectable non-small cell lung cancer in real-world practice

IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Clinical Respiratory Journal Pub Date : 2024-05-01 DOI:10.1111/crj.13761
Xiaojie Huang, Guanchao Pang, Zhirong Mao, Baizhou Li, Zhihua Teng, Yan Yang, Zijian Qiu, Xiuxiu Chen, Pingli Wang
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Abstract

Background

In order to improve survival outcomes in resectable non-small cell lung cancer (NSCLC), strategies for neoadjuvant therapy need to be revisited. We evaluated and compared the efficacy of different neoadjuvant therapeutic modalities in a real-world setting.

Methods

A total of 258 patients with clinical stage IIA to IIIB NSCLC was included. All the patients underwent surgical resection after one to four cycles of neoadjuvant treatment consisting of chemotherapy (83), immunotherapy (23), and immunotherapy plus chemotherapy (152).

Results

The radiologic response rate in the combined immunochemotherapy group was 67.8%, higher than that of 48.2% in the chemotherapy group and 4.3% in the immunotherapy group (p < 0.001). An improved major pathological response (MPR) was also achieved in the combined therapy group compared with the chemotherapy group and the immunotherapy group (53.9% vs. 10.8% vs. 8.7%, p < 0.001). Patients in the combined therapy group had a significant trend toward longer disease-free survival than those in the chemotherapy alone group (3-year disease-free survival [DFS] of 68.79% vs. 50.81%; hazard ratio [HR] for progression or death, 0.477; p = 0.003). Multivariate Cox analysis identified radical surgery (HR, 0.328; p = 0.033), ypN0–1 stage (HR, 0.591; p = 0.038) and MPR result (HR, 0.362; p = 0.007) to be independent prognostic factors for DFS.

Conclusions

Neoadjuvant treatment with a combination of immunotherapy plus chemotherapy appears to achieve higher radiological and pathological responses than monotherapy for IIA-IIIB NSCLC. Log-rank analysis showed that a better outcome could be expected in patients with the addition of immunotherapy to neoadjuvant chemotherapy if compared with patients with chemotherapy alone in terms of DFS.

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现实世界中治疗可切除非小细胞肺癌的新辅助疗法的相关临床结果
背景 为了提高可切除非小细胞肺癌(NSCLC)的生存率,需要重新审视新辅助治疗策略。我们评估并比较了现实世界中不同新辅助治疗模式的疗效。 方法 共纳入 258 例临床 IIA 期至 IIIB 期 NSCLC 患者。所有患者在接受一至四个周期的新辅助治疗(包括化疗(83例)、免疫治疗(23例)和免疫治疗加化疗(152例))后均接受了手术切除。 结果 免疫化疗联合组的放射学反应率为67.8%,高于化疗组的48.2%和免疫治疗组的4.3%(P< 0.001)。与化疗组和免疫治疗组相比,联合治疗组的主要病理反应(MPR)也有所改善(53.9% vs. 10.8% vs. 8.7%,p <0.001)。与单纯化疗组相比,联合治疗组患者的无病生存期有明显延长趋势(3年无病生存期[DFS]为68.79% vs. 50.81%;病情进展或死亡的危险比[HR]为0.477;P = 0.003)。多变量考克斯分析发现根治性手术(HR,0.328;P = 0.033)、ypN0-1分期(HR,0.591;P = 0.038)和MPR结果(HR,0.362;P = 0.007)是DFS的独立预后因素。 结论 对 IIA-IIIB NSCLC 采用免疫疗法加化疗联合疗法进行新辅助治疗似乎比单一疗法获得更高的放射学和病理学反应。对数秩分析显示,在新辅助化疗基础上加用免疫疗法的患者与单纯化疗的患者相比,在DFS方面会有更好的预后。
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来源期刊
Clinical Respiratory Journal
Clinical Respiratory Journal 医学-呼吸系统
CiteScore
3.70
自引率
0.00%
发文量
104
审稿时长
>12 weeks
期刊介绍: Overview Effective with the 2016 volume, this journal will be published in an online-only format. Aims and Scope The Clinical Respiratory Journal (CRJ) provides a forum for clinical research in all areas of respiratory medicine from clinical lung disease to basic research relevant to the clinic. We publish original research, review articles, case studies, editorials and book reviews in all areas of clinical lung disease including: Asthma Allergy COPD Non-invasive ventilation Sleep related breathing disorders Interstitial lung diseases Lung cancer Clinical genetics Rhinitis Airway and lung infection Epidemiology Pediatrics CRJ provides a fast-track service for selected Phase II and Phase III trial studies. Keywords Clinical Respiratory Journal, respiratory, pulmonary, medicine, clinical, lung disease, Abstracting and Indexing Information Academic Search (EBSCO Publishing) Academic Search Alumni Edition (EBSCO Publishing) Embase (Elsevier) Health & Medical Collection (ProQuest) Health Research Premium Collection (ProQuest) HEED: Health Economic Evaluations Database (Wiley-Blackwell) Hospital Premium Collection (ProQuest) Journal Citation Reports/Science Edition (Clarivate Analytics) MEDLINE/PubMed (NLM) ProQuest Central (ProQuest) Science Citation Index Expanded (Clarivate Analytics) SCOPUS (Elsevier)
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