Adjuvant treatment for resectable non-small cell lung cancer (NSCLC) has seen significant advancements following the introduction of immune checkpoint inhibitors (ICIs). These therapies, which enhance the immune system’s ability to recognize and target cancer cells, have demonstrated substantial improvements in disease-free survival (DFS) following surgical resection. Recent studies have shown that ICIs can extend DFS, particularly for patients with high Programmed Death-Ligand 1 (PD-L1) expression but also for those with lower levels of PD-L1, suggesting a broader potential for their application. In the IMpower010 trial, atezolizumab improved DFS compared to best supportive care (BSC) in resected stage II–IIIA NSCLC, with a hazard ratio (HR) of 0.66 (95% CI 0.50–0.88) for patients with PD-L1 expression ≥1% and 0.79 (95% CI 0.64–0.96) for the overall stage II–IIIA population. In the PEARLS/KEYNOTE-091 trial, pembrolizumab also demonstrated a DFS benefit over a placebo for patients with stage IB–IIIA disease (HR 0.76; 95% CI 0.63–0.91), with a median DFS of 53.6 months versus 42.0 months. Despite these promising results, challenges remain regarding the optimal selection of patients, particularly in identifying the most effective biomarkers and determining the ideal duration of treatment. While ICIs are generally well-tolerated, immune-related adverse events, although manageable, require careful monitoring, especially when ICIs are used in combination with chemotherapy. Ongoing research is focused on optimizing treatment duration and exploring combination therapies, with the objective of further improving long-term survival outcomes. The integration of immunotherapy in the adjuvant setting represents a significant advancement in the management of resectable NSCLC. This review aims to provide an overview of the current evidence supporting the use of ICIs in the adjuvant treatment of NSCLC, focusing on treatment efficacy, safety profiles, and ongoing research into biomarkers and combination therapies.
随着免疫检查点抑制剂（ICIs）的引入，可切除非小细胞肺癌（NSCLC）的辅助治疗取得了显著进展。这类疗法通过增强免疫系统识别和靶向癌细胞的能力，在手术切除后显著改善了患者的无病生存期（DFS）。近期研究表明，ICIs能够延长DFS，尤其对程序性死亡配体1（PD-L1）高表达患者有效，同时对PD-L1低表达患者也显示出获益，提示其具有更广泛的应用潜力。在IMpower010试验中，对于已切除的II–IIIA期NSCLC患者，atezolizumab相较于最佳支持治疗（BSC）显著改善了DFS：在PD-L1表达≥1%的患者中风险比（HR）为0.66（95% CI 0.50–0.88），而在整体II–IIIA期人群中HR为0.79（95% CI 0.64–0.96）。PEARLS/KEYNOTE-091试验则显示，pembrolizumab在IB–IIIA期患者中较安慰剂显著延长DFS（HR 0.76；95% CI 0.63–0.91），中位DFS分别为53.6个月与42.0个月。 尽管这些结果令人鼓舞，但在患者最佳选择方面仍存在挑战，特别是在确定最有效的生物标志物和最佳治疗持续时间方面。虽然ICIs通常耐受性良好，但免疫相关不良事件仍需密切监测，尤其是在ICIs与化疗联合使用时。当前研究重点在于优化治疗时长及探索联合疗法，旨在进一步提高长期生存结局。免疫治疗在辅助治疗中的应用，标志着可切除NSCLC治疗领域的重大进步。本综述旨在概述当前支持ICIs用于NSCLC辅助治疗的证据，重点关注治疗效果、安全性特征，以及针对生物标志物和联合疗法的持续研究方向。
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