Clinical factors and major pathological response after neoadjuvant chemoimmunotherapy in potentially resectable lung squamous cell carcinoma

Ye Wang; Yingqiu Song; Runze Wang; Yu Wu; Mo Li; Ke Xu; Rong He; Zheng Wang; Qingqing Li; Feng-Ming Spring Kong; Tianlu Wang

doi:10.3389/fonc.2024.1265228

Clinical factors and major pathological response after neoadjuvant chemoimmunotherapy in potentially resectable lung squamous cell carcinoma

Front Oncol. 2024 Apr 12:14:1265228. doi: 10.3389/fonc.2024.1265228. eCollection 2024.

Authors

Ye Wang^{1

2}, Yingqiu Song¹, Runze Wang¹, Yu Wu^{1

2}, Mo Li³, Ke Xu⁴, Rong He⁴, Zheng Wang⁴, Qingqing Li⁵, Feng-Ming Spring Kong^{6

7}, Tianlu Wang^{1

8}

Affiliations

¹ Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Shenyang, Liaoning, China.
² School of Graduate, Dalian Medical University, Dalian, China.
³ Department of Breast Surgery, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China.
⁴ Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China.
⁵ Department of Endoscopy, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China.
⁶ Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
⁷ Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
⁸ Faculty of Medicine, Dalian University of Technology, Dalian, China.

Abstract

Objective: Major pathological response (MPR) helps evaluate the prognosis of patients with lung squamous cell carcinoma (LUSC). However, the clinical factors that affect the achievement of MPR after neoadjuvant chemoimmunotherapy (NCIO) in patients with LUSC remain unclear. This study aimed to explore the clinical factors affecting the MPR after NCIO in patients with potentially resectable LUSC.

Methods: This retrospective study included patients with stage IIB-IIIC LUSC who underwent surgical resection after receiving NCIO at a center between March 2020 and November 2022. In addition to the postoperative pathological remission rate, sex, age, body mass index (BMI), smoking history, TNM stage, hematological and imaging test results, and other indicators were examined before NCIO. According to the pathological response rate of the surgically removed tumor tissue, the patients were split into MPR and non-MPR groups.

Results: In total, 91 LUSC patients who met the study's eligibility criteria were enrolled: 32 (35%) patients in the non-MPR group and 59 (65%) in the MPR group, which included 43 cases of pathological complete remission (pCR). Pre-treatment lymphocyte level (LY) (odds ratio [OR] =5.997), tumor burden (OR=0.958), N classification (OR=15.915), radiographic response (OR=11.590), pulmonary atelectasis (OR=5.413), and PD-L1 expression (OR=1.028) were independently associated with MPR (all P < 0.05). Based on these six independent predictors, we developed a nomogram model of prediction having an area under the curve (AUC) of 0.914 that is simple to apply clinically to predict the MPR. The MPR group showed greater disease-free survival (DFS) than the non-MPR group, according to the survival analysis (P < 0.001).

Conclusion: The MPR rate of NCIO for potentially resectable LUSC was 65%. LY, tumor burden, N classification, radiographic response, pulmonary atelectasis, and PD-L1 expression in patients with LUSC before NCIO were the independent and ideal predictors of MPR. The developed nomogram demonstrated a good degree of accuracy and resilience in predicting the MPR following NCIO, indicating that it is a useful tool for assuring customized therapy for patients with possibly resectable LUSC.

Keywords: biomarkers; lung squamous cell carcinoma; major pathologic response; neoadjuvant chemoimmunotherapy; nomogram.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work is supported by the Fundamental Research Funds for the Central Universities [LD2023032, LD2023011, LD202221], High-end Foreign Experts Recruitment Plan of China [G2023127016L].