| 引用本文: | 宋利伟,刘帅,林海峰,姚恒,程雨婷,车南颖,杨磊,支修益,王冲.局限期小细胞肺癌新辅助治疗主要病理缓解的影响因素分析[J].中国临床新医学,,():-. |
| .局限期小细胞肺癌新辅助治疗主要病理缓解的影响因素分析[J].中国临床新医学,,():-. |
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| 局限期小细胞肺癌新辅助治疗主要病理缓解的影响因素分析 |
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宋利伟1, 刘帅2, 林海峰1, 姚恒1, 程雨婷1, 车南颖1, 杨磊1, 支修益3, 王冲1
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1.首都医科大学附属北京胸科医院;2.呼伦贝尔市第二人民医院;3.首都医科大学宣武医院
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| 摘要: |
| 目的 探讨局限期小细胞肺癌（limited-stage small cell lung cancer, LS-SCLC）手术患者新辅助治疗后主要病理缓解（Major Pathological Response, MPR）的相关影响因素，为临床病理缓解预判及个体化新辅助治疗方案制定提供依据。方法 回顾性纳入 2018年3月至2024年2月于首都医科大学附属北京胸科医院接受新辅助治疗联合手术治疗、且病理缓解评估资料完整的43例LS-SCLC患者。收集患者临床基线资料、新辅助治疗方案、影像学及病理评估数据，按是否达到 MPR分为MPR组与非MPR组；采用单因素及多因素 Logistic 回归分析筛选 MPR 独立影响因素；通过 Log-rank 检验比较两组生存、复发差异，Cox回归分析复发相关危险因素。结果43例患者中24例（55.81%）达到 MPR，19例（44.19%）未达到MPR。单因素分析显示，基线N分期、新辅助治疗方案、吸烟指数及肿瘤体积减少率与 MPR 相关（P<0.05）；多因素 Logistic 回归校正混杂因素后，肿瘤体积减少率为 MPR 独立预测因素（OR=55.799，95% CI：1.091-2853.128，P=0.045）。Cox回归分析显示，主要病理缓解是小细胞肺癌复发的独立影响因素（HR=0.045，95%CI：0.005-0.423，P=0.007）。结论 在局限期小细胞肺癌接受新辅助治疗并达到主要病理缓解（MPR）的患者中，新辅助化疗联合免疫治疗的比例高于单纯新辅助化疗；肿瘤体积缩小率是新辅助治疗后达到 MPR 的独立影响因素，体积缩小率越高，患者实现MPR的可能性越大。本研究结果可为临床病理缓解的预测及个体化新辅助治疗方案的制定提供参考依据。 |
| 关键词: 小细胞肺癌 新辅助治疗 主要病理缓解 手术 预后 |
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| Analysis of Influencing Factors for Major Pathological Response to Neoadjuvant Therapy in Limited-Stage Small Cell Lung Cancer |
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Beijing Chest Hospital, Capital Medical University
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| Abstract: |
| Objective This study aims to identify the factors influencing major pathological response (MPR) following neoadjuvant therapy in patients undergoing surgery for limited-stage small cell lung cancer (LS-SCLC). The goal is to provide evidence to enhance the prediction of pathological responses and to aid in the development of personalized neoadjuvant treatment protocols in clinical settings. Methods A retrospective analysis was performed on a cohort of 43 patients diagnosed with LS-SCLC who underwent neoadjuvant therapy followed by surgical intervention, with comprehensive pathological response data available. This study was conducted at Beijing Chest Hospital, Capital Medical University, from March 2018 to February 2024. Data collected included clinical baseline characteristics, details of neoadjuvant therapy regimens, and imaging and pathological evaluations. Patients were categorized into two groups based on the achievement of MPR: the MPR group and the non-MPR group. To identify independent factors influencing MPR, both univariate and multivariate logistic regression analyses were employed. Differences in survival and recurrence rates between the two groups were assessed using the Log-rank test, and recurrence-related risk factors were examined through Cox regression analysis. Results Among the cohort of 43 patients, 24 individuals (55.81%) achieved MPR, while 19 individuals (44.19%) did not. Univariate analysis identified that baseline N stage, neoadjuvant therapy regimen, smoking index, and tumor volume reduction rate were significantly associated with MPR (P<0.05). Following adjustment for confounding variables using multivariate logistic regression, the tumor volume reduction rate emerged as an independent predictor of MPR (OR=55.799, 95%CI: 1.091-2853.128, P=0.045). Cox regression analysis showed that MPR was an independent influencing factor for tumor recurrence in LS-SCLC (HR=0.045, 95%CI: 0.005–0.423, P=0.007). Conclusion Among patients with limited-stage small cell lung cancer who achieved MPR following neoadjuvant therapy, the proportion receiving combined neoadjuvant chemotherapy and immunotherapy was higher compared to those receiving neoadjuvant chemotherapy alone. The tumor volume reduction rate is an independent determinant for achieving MPR post-neoadjuvant therapy; specifically, a higher reduction rate correlates with an increased likelihood of achieving MPR. The findings of this study may serve as a reference for predicting clinical pathological response and for the development of individualized neoadjuvant treatment regimens. |
| Key words: Small cell lung cancer Neoadjuvant therapy Major pathological response Surgical operation Prognosis |
