可切除非小细胞肺癌围手术期免疫治疗进展
Advances in Perioperative Immunotherapy for Resectable Non-Small Cell Lung Cancer
摘要: 围术期免疫检查点抑制剂与铂类化疗药物联合治疗已成为可切除非小细胞肺癌(NSCLC)治疗的突破性进展。多项随机对照研究显示，术前免疫联合化疗可提高病理缓解率并改善事件无生存期(EFS)，但不同研究在入组人群、分期构成、随访成熟度及统计设计上存在差异，跨研究比较需谨慎。在安全性方面，免疫相关不良事件(irAEs)总体可控，免疫相关肺炎(CIP)在随机试验中发生率较低，真实世界数据显示可能更高(约10%~12%)。这些数据提示在临床应用中需要重视术前评估、感染与放射性改变的鉴别以及分级管理。本文综述了近年来关键随机对照试验和权威指南，分析了围术期免疫治疗的临床策略、治疗效果及安全性管理，为临床个体化决策提供参考，并提出了未来研究的重点方向。
Abstract: Perioperative immunotherapy with immune checkpoint inhibitors and platinum-based chemotherapy has become a breakthrough in the treatment of resectable non-small cell lung cancer (NSCLC). Several randomized controlled trials have shown that neoadjuvant immunochemotherapy can improve pathological response rates and event-free survival (EFS); however, differences in study populations, stage composition, follow-up maturity, and statistical designs necessitate caution when making cross-study comparisons. In terms of safety, immune-related adverse events (irAEs) are generally manageable, with immune-related pneumonitis (CIP) showing lower incidence rates in randomized trials. However, real-world data suggests higher incidences (~10%~12%). These findings highlight the importance of pre-treatment evaluation, differentiation from infections and radiation changes, and graded management in clinical practice. This narrative review summarizes recent key randomized controlled trials and authoritative guidelines, analyzing clinical strategies, treatment outcomes, and safety management of perioperative immunotherapy, providing a reference for individualized clinical decision-making, and proposing key directions for future research.
文章引用：柴鹏飞, 马玉泉. 可切除非小细胞肺癌围手术期免疫治疗进展[J]. 临床医学进展, 2026, 16(3): 4025-4037. https://doi.org/10.12677/acm.2026.1631214

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