Efficacy of sintilimab combined with chemotherapy neoadjuvant in the treatment of stage Ⅲ non-small cell lung cancer
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摘要:
目的 评价信迪利单抗联合化疗新辅助治疗Ⅲ期非小细胞肺癌的近期疗效和安全性。 方法 分析2021年1月~2023年7月我院26例使用信迪利单抗联合化疗新辅助治疗Ⅲ期非小细胞肺癌患者的临床资料，评估患者影像学和病理学效果并观察免疫联合化疗新辅助治疗的安全性。 结果 23例患者完成根治性手术治疗，手术切除率88.5%，22例R0切除，R0切除率95.7%。影像学结果客观缓解率为92.3%（完全缓解率为11.5%，部分缓解为80.8%）；疾病控制率为96.1%，病理完全缓解率为26.1%，主要病理缓解率为60.9%。常见不良反应：白细胞下降（42.3%）、外周神经毒性（46.2%）、消化道不良反应（23.1%）、甲状腺功能异常（11.5%），3级以上不良反应发生率约为7.7%，未发生严重免疫相关不良反应。 结论 信迪利单抗联合化疗新辅助治疗Ⅲ期非小细胞肺癌的疗效显著，R0切除率高，病理缓解率高，安全性可耐受。 Abstract:Objective To evaluate the short-term efficacy and safety of sintilimab combined with chemotherapy neoadjuvant in the treatment of stage Ⅲ non-small cell lung cancer. Methods The clinical data of 26 patients with stage Ⅲ non-small cell lung cancer treated with Sintilimab combined with chemotherapy neoadjuvant therapy in our hospital from January 2021 to July 2023 were analyzed. The imaging and pathological effects of the patients were evaluated. The safety of immunotherapy combined with chemotherapy neoadjuvant therapy was observed. Results Twenty-three patients completed radical surgery with a surgical resection rate of 88.5%, and 22 patients underwent R0 resection with a R0 resection rate of 95.7%. Objective response rate of imaging results was 92.3% (complete response rate was 11.5%, partial response rate was 80.8%). The disease control rate was 96.1%, the pathological complete response rate was 26.1%, and the main pathological response rate was 60.9%. Common adverse reactions: The incidence of leukopenia was 42.3%, peripheral neurotoxicity was 46.2%, gastrointestinal adverse reactions were 23.1%, thyroid dysfunction was 11.5%, and the incidence of grade 3 or above adverse reactions was about 7.7%. No serious immune related adverse reactions had occurred. Conclusion The combination of sintilimab and neoadjuvant chemotherapy has a significant therapeutic effect on stage Ⅲ non-small cell lung cancer, with a high R0 resection rate, high pathological response rate, and tolerable safety. -
Key words:
- sintilimab /
- chemotherapy /
- neoadjuvant therapy /
- stage Ⅲ non-small cell lung cancer /
- efficacy
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图 2 1例肺鳞状细胞癌患者影像和病理评估（完全缓解）
Figure 2. Imaging and pathological evaluation of 1 patient with lung squamous cell carcinoma (complete response). A-B: Enhanced chest CT before neoadjuvant chemotherapy revealed a 4.4 cm mass in the upper lobe of the right lung invading the right upper pulmonary artery; C: Complete imaging response after 3 cycles of neoadjuvant chemotherapy; D: Tracheal pathology of squamous cell carcinoma before neoadjuvant chemotherapy (HE staining, ×10); E: Pathological complete response after 3 cycles of neoadjuvant chemotherapy. Extensive inflammatory cell infiltration, foam macrophages, cholesterol crevices, collagen fiber formation, and neovasculation (HE staining, ×10).
图 3 1例肺腺癌患者影像和病理评估
Figure 3. Imaging and pathological evaluation of 1 patient with lung adenocarcinoma (complete response). A: Contrast-enhanced CT before neoadjuvant chemotherapy revealed a 3.5 cm mass in the upper lobe of the right lung surrounding the right upper pulmonary artery; B: Complete remission after 3 cycles of neoadjuvant chemotherapy; C: Tracheal pathology before neoadjuvant chemotherapy showed adenocarcinoma (HE staining, ×10); D: Pathological complete response after 3 cycles of neoadjuvant chemotherapy. Extensive inflammatory cell infiltration, foam macrophages, cholesterol crevices, collagen fiber formation, and neovasculation (HE staining, ×10).
图 4 1例肺鳞状细胞癌患者影像和病理评估（主要病理缓解）
Figure 4. Imaging and pathological evaluation of 1 patient with lung squamous cell (carcinomamajor pathological remission). A: Enhanced chest CT before neoadjuvant chemotherapy revealed a 6.0 cm mass in the upper lobe of the left lung, mediastinal lymph node enlargement; B: Partial remission after 3 cycles of neoadjuvant chemotherapy; C: Pathological findings after 3 cycles of neoadjuvant chemotherapy showed major pathological remission, and the proportion of residual tumor cells ≤10% (HE staining, ×10).
表 1 26例患者一般资料
Table 1. Clinical data of the 26 patients [n(%)]
Characteristics All patients (n=26) Gender Male 23（88.5） Female 3（11.5） Age (year) < 60 5（19.2） ≥60 21（80.8） Smoking status Yes 17（65.4） No 9（34.6） Tumor site Upper lobe of right lung 11（42.3） Middle lobe of right lung 2（7.70） Upper lobe of left lung 8（30.8） Inferior lobe of left lung 5（19.2） Pathological type Squamous cell carcinoma 16（61.5） Adenocarcinoma 8（30.8） Poorly differentiated carcinoma 1（3.85） Invasive carcinoma 1（3.85） Clinical disease stage ⅢA 14(53.8) ⅢB 10(38.5) ⅢC 2(7.7) ECOG 0-1 11（42.3） 2 15（57.7） Expression level of PD-L1 < 1% 10（38.5） 1%-49% 16（61.5） ECOG: Eastern cooperative oncology group. 
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表 2 23例患者的手术资料
Table 2. Surgical data of 23 patients [n(%)]
Characteristics All patients (n=23) Degree of excision R0 excision 22（95.7） R1 excision 1（4.30） Surgical procedure Lobectomy 20（87.1） Compound lobectomy 1（4.30） Complete resection of one lung 2（8.60） Mode of operation Thoracoscope 19（87.1） Open the chest 2（8.60） Conversion thoracotomy 1（4.30） Common surgical complications Atrial fibrillation 5（21.7） Mild pneumonia 8（34.9） Cardiac insufficiency 2（8.60） Bronchopleural fistula 1（4.30） Pathological remission Complete remission 6（26.1） Major pathological remission 14（60.9）
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