Introduction: Predictive biomarkers associated with pathological response, progression precluding surgery, and/or recurrence after surgery are needed for patients with resectable non-small cell lung carcinoma (NSCLC) treated by neoadjuvant treatment. We evaluated the clinical impact of the pretreatment tumor growth rate (TGR0) and radiological response for patients with resectable NSCLC treated with neoadjuvant therapies. Methods: Consecutive patients with resectable stage IB (≥4 cm) to IIIA NSCLC treated by neoadjuvant platinum-doublet chemotherapy with or without nivolumab at our tertiary center were retrospectively analyzed. TGR0and RECIST objective responses were determined. Multivariable analyses identified independent predictors of event-free survival (EFS), overall survival (OS), and major pathological response (MPR). Results: Between November 2017 and December 2022, 32 patients (mean [SD] age, 63.8 [8.0] years) were included. At a median follow-up of 54.8 months (95% CI, 42.3–60.4 months), eleven patients (34%) experienced progression or recurrence, and twelve deaths (38%) were recorded. The TGR0cutoff of 30%/month remained the only independent factor associated with EFS (HR = 0.04; 95% CI, 0.01–0.3;p= 0.003) and OS (HR = 0.2; 95% CI, 0.03–0.7;p= 0.01). The TGR0cut-off had a mean time-dependent AUC of 0.83 (95% CI, 0.64–0.95) and 0.80 (95% CI, 0.62–0.97) for predicting EFS and OS, respectively. Fifteen of 26 resection cases (58%) showed MPR including nine with pathological complete responses (35%). Only the objective response of the primary tumor was associated with MPR (OR = 27.5; 95% CI, 2.6–289.1;p= 0.006). Conclusions: Assessment of TGR0can identify patients who should benefit from neoadjuvant treatment. A tumor objective response might be a predictor of MPR after neoadjuvant treatment, which will help to adapt surgical management.
引言：对于接受新辅助治疗的可切除非小细胞肺癌（NSCLC）患者，需要寻找与病理缓解、术前进展和/或术后复发相关的预测性生物标志物。本研究评估了治疗前肿瘤生长速率（TGR0）和影像学反应对接受新辅助治疗的可切除NSCLC患者的临床影响。方法：回顾性分析本三级医疗中心连续收治的、接受含铂双药化疗联合或不联合纳武利尤单抗新辅助治疗的IB期（≥4 cm）至IIIA期可切除NSCLC患者。测定TGR0及RECIST客观缓解率。通过多变量分析确定无事件生存期（EFS）、总生存期（OS）及主要病理缓解（MPR）的独立预测因素。结果：2017年11月至2022年12月期间，共纳入32例患者（平均[SD]年龄63.8[8.0]岁）。中位随访54.8个月（95% CI，42.3-60.4个月）期间，11例患者（34%）出现进展或复发，记录到12例死亡（38%）。30%/月的TGR0截断值始终是EFS（HR=0.04；95% CI，0.01-0.3；p=0.003）和OS（HR=0.2；95% CI，0.03-0.7；p=0.01）的唯一独立相关因素。该TGR0截断值预测EFS和OS的时间依赖性平均AUC分别为0.83（95% CI，0.64-0.95）和0.80（95% CI，0.62-0.97）。26例接受切除术的患者中，15例（58%）达到MPR，其中9例（35%）实现病理完全缓解。仅原发肿瘤的客观缓解与MPR相关（OR=27.5；95% CI，2.6-289.1；p=0.006）。结论：TGR0评估可筛选出可能从新辅助治疗中获益的患者。肿瘤客观缓解可能作为新辅助治疗后MPR的预测指标，有助于指导手术方案的调整。
肿瘤(癌症)患者之家