Background: The advent of immunotherapy has significantly improved survival outcomes in advanced non-small cell lung cancer (NSCLC). In this evolving context, salvage surgery has emerged as a potential curative strategy, despite the risk of serious complications. This study aimed to evaluate the safety and efficacy of surgical resection following chemo-immunotherapy in patients with initially unresectable NSCLC. Methods: We retrospectively analyzed patients with stage III–IVB NSCLC who underwent salvage surgery at our institution between January 2019 and June 2024. All cases were initially deemed unresectable by a multidisciplinary tumor board. Perioperative complications, complete (R0) resection rate, major pathologic response (MPR), complete pathologic response (pCR), progression-free survival (PFS), and overall survival (OS) were analyzed. Results: Twenty-one patients (thirteen males, eight females; median age: 68 years [IQR: 9]) were included. Reasons for initial unresectability were metastatic disease (28.6%), N2 bulky disease (14.3%), local invasiveness (33.3%), or a combination of factors (23.7%). Chemo-immunotherapy was administered in 19 patients (90.5%), while 2 (9.5%) received immunotherapy alone, with a median of four treatment cycles (IQR: 1). Complete (R0) resection was achieved in all patients (100%). Anatomical resections were performed in 17 patients (81%), predominantly lobectomies (66.7%). There were no intraoperative or major postoperative complications, and 30-day mortality was zero. Median hospital stay was 7 days (IQR: 4). pCR and MPR were achieved in 33.3% and 14.3% of patients, respectively. After a median follow-up of 17 months (IQR: 19), the estimated 3-year PFS and OS were 50.9% and 66.3%, respectively. Recurrences included locoregional (4.8%), distant (14.3%), and combined (14.3%). Cox regression analysis identified stage III at diagnosis (OR: 0.292; 95% CI: 0.093–0.912;p= 0.034) and achieved pCR or MPR (OR: 0.113; 95% CI: 0.013–0.959;p= 0.046) as independent predictors of improved PFS. Conclusions: Salvage surgery after chemo-immunotherapy in initially unresectable NSCLC appears to be a safe and effective strategy in selected patients, offering favorable pathological responses and encouraging mid-term oncologic outcomes.
背景：免疫治疗的出现显著改善了晚期非小细胞肺癌（NSCLC）患者的生存结局。在此背景下，挽救性手术作为一种潜在根治策略应运而生，尽管存在严重并发症风险。本研究旨在评估初始不可切除NSCLC患者接受化疗-免疫治疗后手术切除的安全性与有效性。方法：我们回顾性分析了2019年1月至2024年6月期间在本机构接受挽救性手术的III–IVB期NSCLC患者。所有病例经多学科肿瘤委员会评估均为初始不可切除。分析指标包括围手术期并发症、完全（R0）切除率、主要病理缓解（MPR）、完全病理缓解（pCR）、无进展生存期（PFS）和总生存期（OS）。结果：共纳入21例患者（男性13例，女性8例；中位年龄68岁[IQR：9]）。初始不可切除原因包括转移性疾病（28.6%）、N2巨块型病变（14.3%）、局部侵犯（33.3%）或复合因素（23.7%）。19例（90.5%）接受化疗-免疫治疗，2例（9.5%）仅接受免疫治疗，中位治疗周期数为4（IQR：1）。所有患者均实现完全（R0）切除（100%）。17例（81%）接受解剖性切除术，其中肺叶切除术占主导（66.7%）。无术中或重大术后并发症发生，30天死亡率为零。中位住院时间为7天（IQR：4）。分别有33.3%和14.3%的患者达到pCR和MPR。中位随访17个月（IQR：19）后，预估3年PFS和OS分别为50.9%和66.3%。复发类型包括局部区域复发（4.8%）、远处转移（14.3%）及复合复发（14.3%）。Cox回归分析显示，诊断时为III期（OR：0.292；95% CI：0.093–0.912；p=0.034）以及达到pCR或MPR（OR：0.113；95% CI：0.013–0.959；p=0.046）是改善PFS的独立预测因素。结论：对于经选择的初始不可切除NSCLC患者，化疗-免疫治疗后的挽救性手术是一种安全有效的策略，可获得良好的病理缓解和令人鼓舞的中期肿瘤学结局。
肿瘤(癌症)患者之家