Efficacy and safety of sleeve pulmonary resection after neoadjuvant immunotherapy combined with chemotherapy in treatment of non-small cell lung cancer
10.3760/cma.j.cn115355-20250520-00245
- VernacularTitle:新辅助免疫治疗联合化疗后袖式肺切除术治疗非小细胞肺癌的效果和安全性研究
- Author:
Shengzu PENG
1
;
Guanghua ZHENG
1
;
Tao LU
1
Author Information
1. 山西省肿瘤医院 中国医学科学院肿瘤医院山西医院 山西医科大学附属肿瘤医院胸外科，太原 030013
- Publication Type:Journal Article
- Keywords:
Carcinoma, non-small-cell lung;
Neoadjuvant therapy;
Immunotherapy;
Chemotherapy, adjuvant;
Sleeve lobectomy
- From:
Cancer Research and Clinic
2025;37(10):760-765
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of sleeve pulmonary resection after neoadjuvant immunotherapy combined with chemotherapy in the treatment of non-small cell lung cancer.Methods:A retrospective cohort study was conducted. The clinical data of 61 patients with non-small cell lung cancer who underwent sleeve pulmonary resection surgery at Shanxi Province Cancer Hospital from January 2018 to December 2024 were retrospectively analyzed. According to the preoperative neoadjuvant therapy, the patients were divided into the immunotherapy combined with chemotherapy group (26 cases) and the chemotherapy group (35 cases). The efficacy and incidence of adverse reactions of neoadjuvant therapy between two groups of patients were compared.Results:The open surgery was the main surgical approach in both the immunotherapy combined with chemotherapy group and the chemotherapy group, accounting for 61.5% (16/26) and 74.3% (26/35), respectively. The surgical approach of 10 cases (38.5%, 10/26) in the immunotherapy combined with chemotherapy group and 9 cases (25.7%, 9/35) in the chemotherapy group was thoracoscopy, and the difference was not statistically significant ( χ2 = 1.13, P = 0.288); the most common postoperative complications were persistent pulmonary air leakage [30.8% (8/26) in the immunotherapy combined with chemotherapy group and 22.9% (8/35) in the chemotherapy group] and lung infection [19.2% (5/26) in the immunotherapy combined with chemotherapy group and 17.1% (6/35) in the chemotherapy group], with no statistically significant differences (both P > 0.05). Two cases (5.7%) in the chemotherapy group experienced worsening pulmonary infection leading to respiratory failure and died within 90 days after surgery, but there were no cases of death within 90 days in the immunotherapy combined with chemotherapy group ( P > 0.05). One patient in each group (3.8% of the immunotherapy combined chemotherapy group and 2.9% of the chemotherapy group) underwent the second surgery due to persistent hemoptysis after surgery, and further underwent pneumonectomy. After the second surgery, the patients recovered and were discharged. There was no statistically significant difference in intraoperative bleeding, surgical time, postoperative tubing time, and hospitalization time between the two groups of patients (all P > 0.05). Postoperative pathology showed that both groups achieved R 0 resection. The main pathological remission (MPR) rate in the immunotherapy combined chemotherapy group was 65.4% (17/26), while the MPR rate in the chemotherapy group was 20.0% (7/35), with a statistically significant difference ( χ2 = 12.89, P < 0.001); the pathological complete response (PCR) rate in the immunotherapy combined chemotherapy group was 30.8% (8/26), while the PCR rate in the chemotherapy group was 8.6% (3/35), with a statistically significant difference ( χ2 = 4.97, P = 0.026). During the period of neoadjuvant therapy, the incidence of adverse reactions in the immunotherapy combined with chemotherapy group was 80.8% (21/26), while in the chemotherapy group it was 62.9% (22/35); the incidence of ≥ grade 3 adverse reactions was 19.2% (5/26) and 20.0% (7/35), respectively, with no statistically significant differences (both P > 0.05). Conclusions:Patients with non-small cell lung cancer who undergo sleeve pulmonary resection after neoadjuvant immunotherapy combined with chemotherapy have controllable adverse reactions during neoadjuvant therapy, which does not increase the difficulty of surgery or the postoperative complications, and can improve the degree of postoperative pathological remission.
