| 摘要: |
| ［摘要］ 目的 分析局限期小细胞肺癌（LS-SCLC）患者新辅助治疗后获得主要病理缓解（MPR）的影响因素，并分析影响手术预后的因素。方法 回顾性分析2018年3月至2024年2月首都医科大学附属北京胸科医院收治的43例LS-SCLC手术患者的临床资料，术前均接受新辅助治疗。基于手术切除标本的病理学检查结果将患者分为MPR组和非MPR组。通过多因素logistic回归分析影响LS-SCLC患者新辅助治疗后获得MPR的因素。比较两组总生存期（OS）和无疾病生存期（DFS）的差异。通过单因素Cox回归分析影响LS-SCLC患者术后复发的因素。结果 43例患者中24例（55.81%）获得MPR，19例（44.19%）未获得MPR。以单纯新辅助化疗为参考，新辅助化疗联合免疫治疗是促进LS-SCLC患者新辅助治疗后获得MPR的影响因素（P<0.05）。MPR组和非MPR组OS、DFS比较差异均无统计学意义（log-rank检验： χ2=2.579，P=0.324； χ2=2.847，P=0.092）。单因素Cox回归分析结果显示，LS-SCLC患者术后疾病复发与基线T分期具有显著关联性（P<0.05），与性别、年龄、基线N分期、基线神经元特异性烯醇化酶（NSE）、基线胃泌素释放肽前体（Pro-GRP）、术前T分期、术前N分期、新辅助治疗方案、新辅助治疗周期、新辅助治疗后病理缓解结局、新辅助治疗后肿瘤体积减少率、手术方式以及手术范围无显著关联性（P>0.05）。结论 新辅助治疗方案是影响LS-SCLC患者接受新辅助治疗后获得MPR的因素。相比于接受单纯新辅助化疗的患者，接受新辅助化疗联合免疫治疗者获得MPR的概率更高。基线T分期与LS-SCLC患者术后复发有关。 |
| 关键词: 小细胞肺癌 新辅助治疗 主要病理缓解 手术 预后 |
| DOI：10.3969/j.issn.1674-3806.2026.04.05 |
| 分类号: |
| 基金项目:国家自然科学基金项目（编号：82273130） |
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| Analysis on factors influencing major pathological response and surgical outcomes in neoadjuvant therapy for limited-stage small cell lung cancer |
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SONG Liwei1, LIU Shuai2, LIN Haifeng3, YAO Heng1, CHENG Yuting1, CHE Nanying3, YANG Lei1, MA Teng4, ZHI Xiuyi5, WANG Chong1
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1.Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China; 2.Department of Thoracic Surgery, Hulunbuir Second People′s Hospital, Hulunbuir 021000, China; 3.Department of Pathology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China; 4.Tumor Research Center, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China; 5.Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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| Abstract: |
| ［Abstract］ Objective To analyze the factors influencing major pathological response(MPR) following neoadjuvant therapy in limited-stage small cell lung cancer(LS-SCLC) patients, and to analyze the factors affecting the patients′ prognosis after surgery. Methods A retrospective analysis was conducted on the clinical data of 43 patients with LS-SCLC who underwent surgery in Beijing Chest Hospital, Capital Medical University from March 2018 to February 2024. The patients received neoadjuvant therapy before surgery and were divided into MPR group and non-MPR group according to the pathological examination results of the surgical resection specimens. Multivariate logistic regression was used to analyze the factors influencing the LS-SCLC patients to get MPR after neoadjuvant therapy. The differences in overall survival(OS) and disease-free survival(DFS) were compared between the two groups. The factors influencing the recurrence of LS-SCLC in the patients after surgery were analyzed by using univariate Cox regression. Results Among the 43 patients, 24 patients(55.81%) got MPR, while 19 patients(44.19%) did not. Taking neoadjuvant chemotherapy alone as a reference, neoadjuvant chemotherapy combined with immunotherapy was an influencing factor for getting MPR in the LS-SCLC patients after neoadjuvant therapy(P<0.05). There were no statistically significant differences in OS and DFS between the MPR group and the non-MPR group(log-rank test: χ2=2.579, P=0.324; χ2=2.847, P=0.092). The results of univariate Cox regression analysis revealed that postoperative disease recurrence in the LS-SCLC patients was significantly associated with baseline T stage(P<0.05), but was not associated with gender, age, baseline N stage, baseline neuron-specific enolase(NSE), baseline pro-gastrin-releasing peptide(Pro-GRP), preoperative T stage, preoperative N stage, neoadjuvant therapy regimen, number of neoadjuvant therapy cycles, pathological response to neoadjuvant therapy, and the tumor volume reduction rate after neoadjuvant therapy, surgical approach and the extent of resection(P>0.05). Conclusion The neoadjuvant therapy regimen is a factor influencing LS-SCLC patients to get MPR after neoadjuvant therapy. Compared with the patients receiving neoadjuvant chemotherapy alone, those receiving neoadjuvant chemotherapy combined with immunotherapy have a higher probability of getting MPR. Baseline T stage is associated with postoperative recurrence in the LS-SCLC patients. |
| Key words: Small cell lung cancer(SCLC) Neoadjuvant therapy Major pathological response(MPR) Surgery Prognosis |
