过度淋巴结清扫影响免疫治疗效果？来自非小细胞肺癌的研究

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这篇研究发现对于需要接受辅助免疫治疗的NSCLC患者，手术时候精确的淋巴结清扫是有好处的，过度的淋巴结清扫（超过16个淋巴结）将会影响免疫辅助治疗的效果：Impact of lymphadenectomy extent on immunotherapy efficacy in post-resectional recurred non-small cell lung cancer a multi-institutional retrospective cohort study – PubMed

Brief Summary

This paper explores the impact of the number of dissected lymph nodes (DLNs) on the efficacy of immunotherapy in patients with recurrent non-small cell lung cancer (NSCLC) after resection. It proposes an "immunotherapy-driven" lymph node dissection strategy based on findings from a retrospective analysis of NSCLC patients treated with anti-PD-1 immunotherapy.

Key Findings and Methods

Findings:

  1. Efficacy of Immunotherapy: The study found that immunotherapy was effective in patients with post-resectional recurred NSCLC.
  2. Impact of DLN Count: A higher number of dissected lymph nodes (specifically, more than 16) was associated with a poorer response to immunotherapy. Conversely, a lower DLN count (≤16) was correlated with improved progression-free survival (PFS) across all cohorts.
  3. Significance of Lymph Node Preservation: Preserving lymph nodes, particularly those with high central memory T cells (Tcm) proportion, appeared to enhance immunotherapy effectiveness, suggesting the importance of a precise lymphadenectomy strategy.

Methods:

  1. Study Design: The study was a multi-institutional retrospective cohort study, including patients who underwent anti-PD-1 immunotherapy for recurrence between 2018 and 2020.
  2. Data Analysis: Outcomes based on DLN count stratification were assessed. Statistical analysis included multivariable Cox analysis to evaluate the association of DLN count with progression-free survival and Kaplan-Meier method to estimate survival curves.
  3. Immunological Analysis: RNA sequencing was performed on resected lymph node tissues to explore the immunological landscape, focusing on memory T cells, which are crucial for understanding the immunotherapy response.

In summary, the study highlights the nuanced role of lymph node dissection in the treatment of recurrent NSCLC with immunotherapy, suggesting a tailored approach to lymphadenectomy to optimize immunotherapeutic outcomes.

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