Systematic Review of Neoadjuvant Immunotherapy for Patients With Non-Small Cell Lung Cancer.
Systematic Review of Neoadjuvant Immunotherapy for Patients With Non-Small Cell Lung Cancer.
复制标题
非小细胞肺癌患者新辅助免疫治疗的系统评价。
DOI：
10.1053/j.semtcvs.2020.12.012
复制
发表时间：
2021
影响因子：
2.5
通讯作者：
Melfi F
中科院分区：
文献类型：
--
作者：
Cao C;Guo A;Chen C;Chakos A;Bott M;Yang CJ;Zielinski R;Melfi F
新辅助免疫治疗在可切除非小细胞肺癌患者中的作用缺乏可靠的临床证据。该研究的主要目的是确定新辅助免疫治疗的可行性，安全性和有效性的可用数据。使用电子数据库进行了系统评价。根据预先确定的选择标准确定相关研究。确定了4项已完成试验的5篇相关出版物。在大多数研究中，>90%的患者能够在新辅助免疫治疗后的计划时间范围内接受手术。开胸手术的发生率很高，无论是计划的还是从计划的微创方法转换而来的。死亡率范围为0 - 5%，但认为报告的死亡均与给药直接相关。根据与新辅助全身治疗相关的不良事件和术后手术并发症报告发病率。由于随访时间短，生存结局有限。主要病理反应范围为40.5%至56.7%，而原发性肿瘤的完全病理反应范围为15%至33%。根据RECIST标准和氟脱氧葡萄糖亲合力报告放射学缓解。该系统性综述报告了新辅助免疫治疗后接受切除术的患者的安全围手术期结局。然而，开放性开胸手术的发生率相对较高，部分原因是与组织纤维化和炎症增加相关的技术挑战，以及入组研究的患者疾病处于更晚期。未来的研究应集中在确定病理反应的预测因子。新辅助免疫治疗与手术治疗后原发灶的病理学反应
There is a paucity of robust clinical evidence for the role of neoadjuvant immunotherapy in patients with resectable non–small cell lung cancer. The primary aim of the study was to identify the available data on the feasibility, safety and efficacy of neoadjuvant immunotherapy. A systematic review was conducted using electronic databases. Relevant studies were identified according to predefined selection criteria. Five relevant publications on 4 completed trials were identified. In most studies, >90% of patients were able to undergo surgery within the planned timeframe after neoadjuvant immunotherapy. There was a high incidence of open thoracotomy procedures, either planned or converted from a planned minimally invasive approach. Mortality ranged from 0 to 5%, but none of the reported deaths were considered directly treatment-related. Morbidities were reported according to adverse events related to neoadjuvant systemic therapy, and postoperative surgical complications. Survival outcomes were limited due to short follow-up periods. Major pathologic response ranged from 40.5 to 56.7%, whilst complete pathologic response of the primary tumor ranged from 15 to 33%. Radiological responses were reported according to RECIST criteria and fluorodeoxyglucose-avidity. This systematic review reported safe perioperative outcomes of patients who underwent resection following neoadjuvant immunotherapy. However, there was a relatively high incidence of open thoracotomy procedures, partly due to the technical challenges associated with increased fibrosis and inflammation of tissue, as well as the more advanced stages of disease in patients enrolled in the studies. Future studies should focus on identifying predictors of pathological response. Pathological response of primary lesion after neoadjuvant immunotherapy and surgery