Evaluation Of The Efficacy Of Neoadjuvant Immunochemotherapy For Non-Small Cell Lung Cancer And Its Influencing Factors

Objective:In the past decades,lung cancer has been the most common malignant tumor in the world.Despite exploring endless treatment models based on surgery,its survival rate remains worrying.In recent years,the emerging neoadjuvant immunotherapy combined with chemotherapy has achieved excellent results in the treatment of non-small cell lung cancer,significantly improving patient survival.However,the factors that affect its efficacy are rarely discussed.This study analyzes the efficacy of neoadjuvant immunotherapy combined with chemotherapy in the treatment of non-small cell lung cancer(NSCLC),and explores the factors that affect its efficacy,which helps to assess prognostic risks.Methods:This study collected 316 patients with non-small cell lung cancer(NSCLC)who underwent surgery after receiving neoadjuvant immunochemotherapy/neoadjuvant chemotherapy at the First Affiliated Hospital of Guangzhou Medical University between May 2018 and March 2023.244 patients received neoadjuvant immunochemotherapy as the observation group and 72 patients who received neoadjuvant chemotherapy as the control group.We retrospectively analyzed the clinical data of patients in the observation group,including age,gender,body mass index(BMI),pathological type,clinical stage,tumor location,neoadjuvant treatment period,R0 resection rate,lymph node downstaging rate,days between the last neoadjuvant treatment and surgery,and compared CT images before and after the last neoadjuvant treatment using the Response Evaluation Criteria in Solid Tumors(RECIST).In the observation group,peripheral blood platelet count,absolute neutrophil count,absolute lymphocyte count,and serum albumin levels were collected before and after the first neoadjuvant treatment and calculated the pre-therapy systemic immune-inflammation index(pre SII)and pre-therapy prognostic nutritional index(pre PNI)before the first neoadjuvant treatment and the post-therapy systemic immune-inflammation index(pro SII)and pro-therapy prognostic nutritional index(pro PNI)after the first neoadjuvant treatment.Major pathological response(MPR)and pathological complete response(p CR)were used as efficacy indicators to compare the efficacy of patients in the observation group and the control group.The patients in the observation group were divided into MPR group and non-MPR group,as well as p CR group and non-p CR group.Univariate and multivariate logistic regression analyses were performed on factors that may be related to efficacy.Receiver operating characteristic curve(ROC)was plotted for pre SII,pre PNI,pro SII,and pro PNI to analyze their predictive efficacy for MPR and p CR in NSCLC patients undergoing neoadjuvant immune combination chemotherapy.Results:In the observation group,130 patients(53.28%)achieved MPR,while 114patients(46.72%)did not.In addition,90 patients(36.89%)achieved p CR,while 154patients(63.11%)did not.In the control group,19 patients(26.39%)achieved MPR,while 53 patients(73.61%)did not.In addition,12 patients(16.67%)achieved p CR,while 60 patients(83.33%)did not.Correlation analysis was conductedon the observation group.Both univariate and multivariate logistic regression analyses showed that pathological type,tumor location,and postoperative lymph node downstaging were associated with the occurrence of MPR.Specifically,squamous cell carcinoma and tumors located in the left lung were associated with a higher incidence of MPR.However,the ROC curve analysis showed that the first-time SII and PNI before and after neoadjuvant immunochemotherapy were not statistically significant in predicting MPR in NSCLC patients.Univariate logistic regression analysis showed that sex,pathological type,and tumor location were associated with the occurrence of p CR,while multivariate logistic regression analysis showed that p CR was not associated with sex,while pathological type and tumor location were.Specifically,squamous cell carcinoma and tumors located in the left lung were associated with a higher incidence of p CR.The ROC curve analysis showed that the first-time SII and PNI before and after neoadjuvant immunochemotherapy were not statistically significant in predicting p CR in NSCLC patients.Conclusion:The MPR rate of NSCLC patients receiving neoadjuvant immunochemotherapy was 53.28% and the p CR rate was 36.89%.Both MPR rate and p CR rate were better than neoadjuvant chemotherapy,indicating an encouraging therapeutic effect and excellent prospects for this treatment strategy,which should be widely promoted.From a clinical perspective,postoperative lymph node downstaging does not establish a causal relationship with MPR,but multivariate analysis suggests its correlation with MPR,indicating that preoperative imaging evaluation of lymph node status after neoadjuvant therapy can reflect the pathological response of the patient to some extent.Pathological type and tumor location are independent predictors of MPR and p CR after neoadjuvant immunochemotherapy in NSCLC patients,with squamous cell carcinoma and left lung tumors associated with more patients achieving MPR and p CR.The first-time SII and PNI before and after neoadjuvant immunochemotherapy had no predictive value for MPR and p CR in NSCLC patients.