文章：

新辅助化疗-免疫治疗后非小细胞肺癌的手术技术：现状与文献综述

Surgical Techniques for Non-Small-Cell Lung Cancer After Neoadjuvant Chemo-Immunotherapy: State of Art and Review of the Literature

原文发布日期：14 February 2025

DOI: 10.3390/cancers17040638

类型: Article

开放获取: 是

英文摘要：

Non-small-cell lung cancer (NSCLC) accounts for 80–85% of all lung cancers. Approximately 20% of patients with NSCLC are diagnosed with stage IIIA–IIIB disease, for which the optimal treatment remains unclear. Meta-analyses reveal that neoadjuvant/perioperative ICI–chemotherapy significantly improves pathological complete response (pCR), overall survival (OS), major pathological response (MPR), and R0 rate compared to standard neoadjuvant chemotherapy. Resectability is achieved when R0 resection can be performed after surgery. Radiographic downstaging often does not correspond to surgical downstaging. In fact, intra-operative fibrosis due to chemo-immunotherapy (synonymous with ICI–chemotherapy) can create adhesions and consequent difficult planes for dissection. Thus, pneumonectomy cannot be avoided. Even the suspicion of N2 after neoadjuvant treatment is considered a limitation of upfront surgery because of the risk of pneumonectomy. The aim of this review is to explore the literature on the technical strategies for surgical excision of NSCLC after chemo-immunotherapy, addressing even the most challenging scenarios.

摘要翻译： 

非小细胞肺癌（NSCLC）占所有肺癌的80%–85%。约20%的NSCLC患者确诊时为IIIA–IIIB期，其最佳治疗方案尚未明确。荟萃分析显示，与标准新辅助化疗相比，新辅助/围手术期免疫检查点抑制剂联合化疗（ICI–化疗）能显著提高病理完全缓解率、总生存率、主要病理缓解率及R0切除率。当术后可实现R0切除时，即达到可切除标准。影像学降期常与手术降期不一致。实际上，化疗免疫治疗（即ICI–化疗）引起的术中纤维化可能造成组织粘连，进而导致解剖层面分离困难，因此部分病例无法避免全肺切除术。甚至新辅助治疗后疑似N2淋巴结转移也被视为直接手术的限制因素，因其可能增加全肺切除风险。本综述旨在通过文献探讨化疗免疫治疗后NSCLC手术切除的技术策略，以应对最具挑战性的临床场景。

原文链接：

Surgical Techniques for Non-Small-Cell Lung Cancer After Neoadjuvant Chemo-Immunotherapy: State of Art and Review of the Literature