CHIO3：化疗联合免疫检查点抑制剂治疗可手术的 IIIA/B 期（N2）非小细胞肺癌：手术结果
CHIO3: CHemotherapy Combined with Immune Checkpoint Inhibitor for Operable Stage IIIA/B (N2) Non-Small Cell Lung Cancer: Surgical Outcomes.
作者
作者单位
- Thoracic Surgery, University of Virginia Cancer Center, Charlottesville, VA. Electronic address: linda.martin@uvahealth.org.
- Alliance Statistics and Data Management Center, Duke University, Durham, NC.
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL; Radiation Oncology, Dana-Farber/Partners Cancer Care, Boston, MA.
- Radiation Oncology, University of California, San Diego, San Diego, CA.
- Thoracic Surgery and Oncology, Northwestern University, Chicago, IL.
- Thoracic Surgery, State University of New York Upstate Medical University, Syracuse, NY.
- Thoracic Surgery, University of Chicago Comprehensive Cancer, Chicago, IL.
- Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC.
摘要
中文
对于 III 期（N2+）非小细胞肺癌，鉴于新辅助/围手术期化疗免疫治疗（ChIO）的显著疗效，手术切除重新引起关注。我们报告了一项纯 N2+ 非小细胞肺癌临床试验中化疗联合 durvalumab 后的手术结果。这是一项在美国 9 家医院进行的单臂 II 期试验。符合条件的患者为可切除的 III 期非小细胞肺癌，且经病理证实为 N2+。患者接受 4 个周期铂类双药 + durvalumab，随后进行肺叶切除或更广泛切除，并接受 1 年辅助 durvalumab。分析手术方式、切缘、淋巴结清扫范围、并发症和治疗及时性。从 2021 年至 2023 年，共入组 37 例患者；30 例接受了手术切除（81%）。手术结果显著：28/30（93.3%）实现 R0 切除，肺切除率为 6.7%（2/30），中位住院时间 3.5 天，30 天和 90 天无死亡。微创手术可行于 19/30（63.3%：2 例 VATS，17 例机器人），其中 2 例中转开胸（总开胸率：11/30：36.7%）。14/30（46.7%）报告手术难度增加。从新辅助治疗到手术的中位间隔为 46 天，从手术到辅助治疗为 35 天。所有推荐辅助治疗的 23 例患者均接受了治疗。该试验为前瞻性记录的 N2+ 非小细胞肺癌接受新辅助 ChIO 治疗后的手术结果提供了见解。在这种具有挑战性的情况下，手术实现了零死亡、高比例微创手术、R0 切除和肺叶切除，并能迅速恢复肿瘤治疗。ChIO 后，N2+ 非小细胞肺癌的切除可获得良好结果，值得在多学科 NSCLC 治疗中给予更多考虑。
English
There is renewed interest in resection of Stage III (N2+) NSCLC given impressive outcomes with neoadjuvant/perioperative chemoimmunotherapy (ChIO). We report surgical outcomes from an exclusively N2+ NSCLC clinical trial following chemotherapy + durvalumab. This was a single arm phase II trial enrolled at 9 US hospitals. Eligible patients had resectable stage III NSCLC, pathologically proven N2+. Patients received 4 cycles of platinum doublet + durvalumab followed by lobectomy or greater, and adjuvant durvalumab for 1 year. Surgical approach, margins, extent of lymphadenectomy, complications, and treatment timeliness were analyzed. From 2021-2023, 37 patients were enrolled; 30 patients underwent resection (81%). Surgical outcomes are notable for R0 resection in 28/30 patients (93.3%), pneumonectomy rate of 6.7% (2/30), median stay 3.5 days, no mortality at 30 and 90 days. Minimally invasive surgery was possible in 19/30 (63.3%: 2 VATS, 17 robotic), with 2 conversions to thoracotomy (total thoracotomy rate: 11/30: 36.7%). Increased surgical difficulty was reported in 14/30 (46.7%). Median interval from neoadjuvant therapy to surgery was 46 days, and from surgery to adjuvant therapy was 35 days. All 23 patients recommended for adjuvant therapy received it. This trial provides insight into surgical outcomes for prospectively documented N2+ NSCLC treated with neoadjuvant ChIO. Surgery in this challenging scenario was accomplished with no mortality, high rates of minimally invasive surgery, R0 resection, and lobectomy, with prompt return to oncologic therapy. Following ChIO, resection of N2+ NSCLC can be achieved with excellent outcomes and warrants stronger consideration within multidisciplinary NSCLC care.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 5.3