| Background and objective:In recent years,neoadjuvant therapies such as single-drug immunization and immunization combination have been proposed one after another,which has greatly changed the treatment pattern of patients with resectable or potentially resectable non-small cell lung cancer.Preliminary studies have found that neoadjuvant immunotherapy is more effective than neoadjuvant chemotherapy,especially the combination of immunotherapy and chemotherapy has more advantages,but the adverse reactions and complications during the perioperative period have also become issues worthy of attention.Some studies have shown that severe adverse reactions may lead to delays in surgery or even missed opportunities for surgery,while severe postoperative complications may endanger the lives of patients.Therefore,the purpose of this study is to retrospectively analyze the characteristics of perioperative adverse reactions and complications of NSCLC patients who received neoadjuvant immunotherapy combined with chemotherapy and completed surgery,and analyze their risk factors,so as to provide reference for clinical practice.Methods:This study collected the clinical data of all NSCLC patients who received neoadjuvant immunotherapy combined with chemotherapy in the Cancer Center of the First Hospital of Jilin University and completed surgery in the Department of Thoracic Surgery from June 1,2020 to December 1,2022.According to the inclusion and exclusion criteria,42 patients were finally enrolled.All data were statistically analyzed using SPSS2 6.0 software,and basic descriptive statistics were used to summarize the data.The χ2 test was used to compare the balance among the groups.The association between categorical variables and occurrence of adverse reactions was analyzed by logistic regression.Receiver operating characteristic curves were used to determine laboratory parameters,and the area under the curve and Youden index were used to determine the cut-off values of the parameters.P<0.05 is statistically significant.Results:1.The median age of the patients was 60 years old(34-75 years old).The pathological type was mainly squamous cell carcinoma,accounting for 92.86%.The TNM stage was mainly stageⅢA patients,accounting for 64.29%.The average operation time of all patients was about 161min(102-330min),the average intraoperative blood loss was about 255ml(50-5000ml),and the rate of conversion to thoracotomy was 2.38%;the average postoperative hospital stay was about 10days(6-68 days),the average postoperative extubation time was about 6 days(3-15 days),and the mortality rate within 90 days after operation was 2.38%.2.A total of 37 patients were assessed for pathological response rate,56.76% of patients achieved major pathologic response(MPR),and 35.14% of patients achieved pathologic complete response(p CR).3.The incidence of adverse reactions of all grades in the perioperative period was 54.76%,and 11.90%(patients had ≥ grade 3 adverse reactions;the incidence of postoperative complications was 45.24%,and 23.81% of patients had ≥ grade 3 postoperative complications Among them,1patient(2.38%)died due to postoperative bronchopleural fistula(BPF).4.This study explored the predictors of adverse reactions.Univariate analysis showed that neutrophil/lymphocyte ratio(NLR),erythrocyte sedimentation rate(ESR),lactate dehydrogenase(LDH),serum albumin(ALB),percentage of CD3+CD4+T cells were significantly correlated with the occurrence of adverse reactions;further multivariate analysis showed that higher NLR(critical value=2.72),higher LDH(critical Value = 173 U/L)and lower ALB(critical value = 37.07 g/L)were independent risk factors for adverse reactions of neoadjuvant immunization combined with chemotherapy.5.Based on the summary of the clinical characteristics of 5 patients with BPF,it can be seen that central lung cancer,pneumonectomy and surgical timing may be related to the occurrence of bronchopleural fistula.Conclusions:1.The incidences of perioperative adverse reactions and postoperative complications of neoadjuvant immunotherapy combined with chemotherapy were 54.76% and 45.24%,and the incidences of grade ≥ 3 adverse reactions and complications were 11.90% and 23.81%,respectively.2.Higher NLR(critical value=2.72),higher LDH(critical value=173 U/L)and lower ALB(critical value=37.07 g/L)were independent risks of adverse reactions of neoadjuvant immunotherapy combined with chemotherapy factor.3.BPF is a serious and fatal complication after pneumonectomy,which should attract the attention of clinicians.Central lung cancer,pneumonectomy,operation time and earlier operation timing may be risk factors for postoperative BPF. |
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